Prevention of Postherniorrhaphy Urinary Retention with Prazosin

Abstract

Urinary retention that necessitates catheterization after herniorrhaphy is a well known, but usually ignored, situation. Increased sympathetic activity resulting from surgery may be the contributing factor. Blockade of a receptors in the bladder neck and urethral sphinchter may prevent postoperative urinary retention. In this prospective placebo-controlled study, the efficacy of prazosin in preventing postoperative urinary retention after herniorrhaphy was investigated in 156 patients. Patients were randomized into two groups. Patients in Group I (control) were given placebo orally 12 hours before surgery, just before surgery, and 12 and 24 hours after surgery. In Group II, 1 mg of prazosin was given in the same manner of placebo. Nine of 84 patients (10.8%) in the prazosin group and 18 of 72 patients (25%) in the placebo group developed urinary retention. Catheterization was required in only 3 patients (3.5%) in the prazosin group compared to 10 patients (13.8%) in placebo-treated group (P < 0.05). In conclusion, prophylactic use of prazosin after herniorrhaphy significantly reduced the incidence of urinary retention and catheterization.

Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial

“…13 Prazosin was also investigated in another randomized controlled trial in which 156 patients underwent elective herniorrhaphy and were randomly assigned to receive perioperative prazosin or placebo. 15 The authors found that 3.5% of patients who received the study drug developed POUR compared with 25% of patients in the placebo group (p < 0.05).…”

“…5 One theorized cause of POUR is the activation of alpha adrenergic receptors in the bladder neck and proximal urethra. [13][14][15][16][17][18] This hypothesis is supported by the observation that some anesthetic agents are alpha adrenergic agonists. Patients treated with these agents, including ephedrine and phenylephrine, have increased risk of developing POUR.…”

“…16,19,20 Several small trials have investigated the use of alpha adrenergic receptor blockers, such as tamsulosin, to reduce POUR. Compared with placebo, alpha blockers have been demonstrated to reduce the incidence of POUR by as much as 83%, 15,17,21 whereas others have shown no benefit. 13,22 All prospective trials performed to date have been small and point to the need for a large randomized controlled trial.…”

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

“…The incidence of POUR following IHR in other studies has varied substantially, with incidence rates of 1.4% to 22.2% reported after minimally invasive IHR; 0.7% to 38% following open IHR; and 0.8% to 13% in mixed cohorts . This wide variation may reflect heterogeneity in both practice and data recording.…”

Prophylactic alpha blockers fail to prevent postoperative urinary retention following orthopaedic procedures: evidence from a meta-analysis and trial sequential analysis of comparative studies

“…Chapman et al reported that tamsulosin was effective in preventing POUR following female pelvic reconstructive surgery (Lose and Lindholm, 1985;Chapman et al, 2021). Similarly, Gönüllü et al found that prophylactic administration of prazosin could reduce the incidence of POUR and catheterization following herniorrhaphy (Gönüllü et al, 1999).…”