Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia

Ali Akkoc, Cemil Aydin, Ramazan Topaktas, Mahir Kartalmis, Selcuk Altin, Kenan Isen, Ahmet Metin, Ali Akkoc, Cemil Aydin, Ramazan Topaktas, Mahir Kartalmis, Selcuk Altin, Kenan Isen, Ahmet Metin

Abstract

Purpose: Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia.

Materials and methods: A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded.

Results: There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697).

Conclusion: This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Conflict of interest statement

CONFLICT OF INTEREST

None declared.

References

    1. Marx GF. The first spinal anesthesia. Who deserves the laurels? Reg Anesth. 1994;19:429–430.
    1. Tarkkila P. Complications associated with spinal anesthesia. In: Finucane BT, ed, editor. Complications of regional anesthesia. New York: Springer; 2007. pp. 149–166.
    1. Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139–1157.
    1. Darrah DM, Griebling TL, Silverstein JH. Postoperative urinary retention. Anesthesiol Clin. 2009;27:465–484.
    1. Lingaraj K, Ruben M, Chan YH, Das SD. Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience. Singapore Med J. 2007;48:213–216.
    1. Lucas MG, Stephenson TP, Nargund V. Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int. 2005;95:354–357.
    1. Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM. Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention. Eur Urol. 2002;42:329–332.
    1. Kreutziger J, Frankenberger B, Luger TJ, Richard S, Zbinden S. Urinary retention after spinal anaesthesia with hyperbaric prilocaine 2% in an ambulatory setting. Br J Anaesth. 2010;104:582–586.
    1. Wohlrab KJ, Erekson EA, Korbly NB, Drimbarean CD, Rardin CR, Sung VW. The association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures. 571Am J Obstet Gynecol. 2009;200 e1-5.
    1. Madani AH, Aval HB, Mokhtari G, Nasseh H, Esmaeili S, Shakiba M, et al. Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study. Int Braz J Urol. 2014;40:30–36.
    1. Chen J, Matzkin H, Lazauskas T, Lelcuk S, Braf Z. Posthernioplasty urinary retention: a noninvasive work-up for prediction. Urol Int. 1993;51:243–245.
    1. Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg. 1999;89:90–97.
    1. Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology. 2002;97:315–319.
    1. Lanz E, Grab BM. Micturition disorders following spinal anesthesia of different durations of action (lidocaine 2% versus bupivacaine 0.5%) Anaesthesist. 1992;41:231–234.
    1. Kamphuis ET, Ionescu TI, Kuipers PW, Gier J, van Venrooij GE, Boon TA. Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology. 1998;88:310–316.
    1. Durant PA, Yaksh TL. Drug effects on urinary bladder tone during spinal morphine-induced inhibition of the micturition reflex in unanesthetized rats. Anesthesiology. 1988;68:325–334.
    1. Petros JG, Rimm EB, Robillard RJ, Argy O. Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy. Am J Surg. 1991;161:431–433.
    1. Lee SJ, Kim YT, Lee TY, Woo YN. Analysis of risk factors for acute urinary retention after non-urogenital surgery. Korean J Urol. 2007;48:1277–1284.
    1. Zaheer S, Reilly WT, Pemberton JH, Ilstrup D. Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum. 1998;41:696–704.
    1. Buckley BS, Lapitan MC. Drugs for treatment of urinary retention after surgery in adults. Cochrane Database Syst Rev. 2010;10:
    1. Janane A, Hamdoun A, Hajji F, Dakkak Y, Ghadouane M, Ameur A, et al. Usefulness of adjunctive alpha1-adrenergic antagonists after single extracorporeal shock wave lithotripsy session in ureteral stone expulsion. Can Urol Assoc J. 2014;8:E8–E11.
    1. Agrawal MS, Yadav A, Yadav H, Singh AK, Lavania P, Jaiman R. A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia. Indian J Urol. 2009;25:474–478.
    1. Altarac S. Alpha-adrenergic blockers as a support in the treatment of acute urinary retention. Lijec Vjesn. 2006;128:233–237.
    1. Lee M. Alfuzosin hydrochloride for the treatment of benign prostatic hyperplasia. Am J Health Syst Pharm. 2003;60:1426–1439. Erratum in: Am J Health Syst Pharm. 2004;61:437.

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