Tamsulosin vs placebo to prevent postoperative urinary retention following female pelvic reconstructive surgery: a multicenter randomized controlled trial

Chapman, Graham; Sheyn, David; Slopnick, Emily; Roberts, Kasey; El-Nashar, Sherif; Henderson, Joseph W.; Mangel, Jeffrey; Hijaz, Adonis; Pollard, R.R.; Mahajan, Sahil

doi:10.1016/j.ajog.2021.04.236

Cited by 20 publications

(14 citation statements)

References 35 publications

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“…After the initial literature search and after the second Delphi survey, more information was published regarding the use of tamsulosin (an α-blocker) to reduce POUR. This included a new RCT that was a follow-up to a retrospective study done by the same group of investigators 114,115 . Question 37 was a statement on the use of medications after surgery to prevent or treat POUR and had already reached 100% consensus in the first Delphi survey.…”

Section: Resultsmentioning

confidence: 99%

“…Despite an RCT showing that bethanechol may increase passing a VT after radical hysterectomy, 17 there is currently a lack of evidence to support the routine use of preoperative bethanechol to reduce POUR in women after PRS. A recent RCT using tamsulosin in patients undergoing POP surgery found that a dose of 0.4 mg taken daily for 3 days before the surgical procedure decreased the risk of POUR with odds ratio 0.28 (95% confidence interval [CI], 0.09–81) 114 . The same group of authors previously reported a retrospective study also showing a decreased risk of developing POUR 115 so it seems that this intervention has promise in this patient population.…”

Section: Discussionmentioning

confidence: 97%

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Postoperative Urinary Retention

McDermott

Tunitsky-Bitton

Dueñas-García

et al. 2023

UROGC

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This clinical consensus statement on the management of postoperative (<6 weeks) urinary retention (POUR) reflects statements drafted by content experts from the American Urogynecologic Society's POUR writing group. The writing group used a modified Delphi process to evaluate statements developed from a structured literature search and assessed for consensus. After the definition of POUR was established, a total of 37 statements were assessed in the following 6 categories:(1) incidence of POUR, (2) medications, (3) patient factors, (4) surgical factors, (5) urodynamic testing, and (6) voiding trials. Of the 37 original statements, 34 reached consensus and 3 were omitted.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Postoperative Urinary Retention

McDermott

Tunitsky-Bitton

Dueñas-García

et al. 2023

UROGC

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“…To improve bladder emptying, decreasing outlet resistance through sympathetic blockade at the bladder neck has been investigated. In a 2021 double-blind RCT, Chapman et al [38] assessed whether tamsulosin is effective in preventing postoperative urinary retention (POUR) in women undergoing surgery for pelvic organ prolapse. Of 119 patients, 57 received tamsulosin and 62 received placebo.…”

Section: Management Of Acute Urinary Retention In Womanmentioning

confidence: 99%

Best nonsurgical managements of acute urinary retention: what's new?

Baboudjian

Benoit

Boissier

et al. 2021

Current Opinion in Urology

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Purpose of reviewTo provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). Recent findingsA recent meta-analysis confirmed that a-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (À89.68 min, 95% confidence interval À160.55, À18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.

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“…Postoperative urinary retention requires an indwelling catheter or intermittent self-catheterization, which can be associated with urinary tract infection, catheter-related complications, patient discomfort and dissatisfaction, and increased health care costs 6–9 . Risk factors for urinary retention after pelvic reconstructive surgery include increasing age, medical comorbidities, degree of prolapse, procedure time, surgical blood loss, pain, and concomitant midurethral sling placement 10–13 . In addition, with the recent implementation of enhanced recovery after surgery (ERAS) protocols in pelvic reconstructive surgery, studies are forthcoming regarding the effects of these interventions on PUR 14 …”

mentioning

confidence: 99%

“…[6][7][8][9] Risk factors for urinary retention after pelvic reconstructive surgery include increasing age, medical comorbidities, degree of prolapse, procedure time, surgical blood loss, pain, and concomitant midurethral sling placement. [10][11][12][13] In addition, with the recent implementation of enhanced recovery after surgery (ERAS) protocols in pelvic reconstructive surgery, studies are forthcoming regarding the effects of these interventions on PUR. 14 The ERAS protocols have been well established across surgical disciplines to facilitate postoperative recovery and improve clinical outcomes such as length of stay, return of bowel function, postoperative pain control, and patient satisfaction.…”

mentioning

confidence: 99%

Effects of Preoperative Gabapentin on Clinical Outcomes After Outpatient Midurethral Sling Placement

Welch

Dengler

DiCarlo-Meacham

et al. 2022

Female Pelvic Med Reconstr Surg

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ObjectivesThis study aimed to evaluate transient urinary retention in women undergoing outpatient midurethral sling placement who received preoperative gabapentin (treated) versus those who did not (untreated). Secondary outcomes included unexpected admission rates, analgesic usage, time to discharge, and pain.MethodsThis was a retrospective cohort study including women who underwent outpatient midurethral sling placement from 2015 to 2019. Exclusion criteria included suprapubic catheter placement, planned overnight admission, abnormal preoperative postvoid residual volume, and prolonged postoperative catheterization. Logistic regression was performed to evaluate gabapentin usage and urinary retention after adjusting for patient characteristics.ResultsThree hundred two women met the inclusion criteria, with 19.5% experiencing urinary retention after midurethral sling placement. Women older than 65 years were more likely to have urinary retention than those aged 18–65 years (29.8% vs 17.6%, P = 0.054). Of treated participants, 26% had urinary retention versus 18% of untreated participants (P = 0.162). Adjusting for age, parity, pain, operative time, blood loss, sling type, analgesic, scopolamine patch, or hemostatic agent use, treated participants had 72% higher odds of urinary retention (adjusted odds ratio, 1.72; 95% confidence interval, 0.88–3.38; P = 0.113). There was no difference in unexpected admission, analgesic usage, time to discharge, or pain between groups.ConclusionsOne of 5 women had urinary retention after outpatient midurethral sling placement. Although no statistically significant difference was found in urinary retention between groups, the odds of urinary retention in the treated group were increased. Because there was no difference in pain, analgesic usage, or time to discharge between groups, investigation regarding gabapentin use for outpatient urogynecologic surgery is needed.

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Tamsulosin vs placebo to prevent postoperative urinary retention following female pelvic reconstructive surgery: a multicenter randomized controlled trial

Cited by 20 publications

References 35 publications

Postoperative Urinary Retention

Postoperative Urinary Retention

Best nonsurgical managements of acute urinary retention: what's new?

Effects of Preoperative Gabapentin on Clinical Outcomes After Outpatient Midurethral Sling Placement

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