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Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis.
Eur Urol. 2019 05; 75(5):788-798.EU

Abstract

CONTEXT

Practice patterns for the management of urinary retention (UR) secondary to benign prostatic obstruction (BPO; UR/BPO) vary widely and remain unstandardized.

OBJECTIVE

To review the evidence for managing patients with UR/BPO with pharmacological and nonpharmacological treatments included in the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms.

EVIDENCE ACQUISITION

Search was conducted up to April 22, 2018, using CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. This systematic review included randomized controlled trials (RCTs) and prospective comparative studies. Methods as detailed in the Cochrane handbook were followed. Certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

EVIDENCE SYNTHESIS

Literature search identified 2074 citations. Twenty-one studies were included (qualitative synthesis). The evidence for managing patients with UR/BPO with pharmacological or nonpharmacological treatments is limited. CoE for most outcomes was low/very low. Only α1-blockers (alfuzosin and tamsulosin) have been evaluated in more than one RCT. Pooled results indicated that α1-blockers provided significantly higher rates of successful trial without catheter compared with placebo [alfuzosin: 322/540 (60%) vs 156/400 (39%) (odds ratio {OR} 2.28, 95% confidence interval {CI} 1.55 to 3.36; participants=940; studies=7; I2=41%; low CoE); tamsulosin: 75/158 (47%) vs 40/139 (29%) (OR 2.40, 95% CI 1.29 to 4.45; participants=297; studies=3; I2=30%; low CoE)] with rare adverse events. Similar rates were achieved with tamsulosin or alfuzosin [51/87 (59%) vs 45/84 (54%) (OR 1.28, 95% CI 0.68 to 2.41; participants=171; studies=2; I2=0%; very low CoE)]. Nonpharmacological treatments have been evaluated in RCTs/prospective comparative studies only sporadically.

CONCLUSIONS

There is some evidence that usage of α1-blockers (alfuzosin and tamsulosin) may improve resolution of UR/BPO. As most nonpharmacological treatments have not been evaluated in patients with UR/BPO, the evidence is inconclusive about their benefits and harms.

PATIENT SUMMARY

There is some evidence that alfuzosin and tamsulosin may increase the rates of successful trial without catheter, but little or no evidence on various nonpharmacological treatment options for managing patients with urinary retention secondary to benign prostatic obstruction.

Authors+Show Affiliations

Center of Minimal Invasive Urology Athens Medical Center, Athens, Greece.Department of Urology, University of Patras, Patras, Greece.Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK.Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.Department of Urology, Charles-Nicolle University Hospital, Rouen Cedex, France.Translational Health Sciences, Bristol Medical School, University of Bristol and Bristol Urological Institute, Bristol, UK.Minimally Invasive and Robotic Surgery, and Kidney Transplantation, University of Florence AOUC-Careggi Hospital, Florence, Italy.Department of Urology, Albert-Ludwigs-University, Freiburg, Germany.Urology Clinic, Spital Thurgau AG, Frauenfeld, Switzerland; Department of Urology and Urological Oncology, Hanover Medical School, Hanover, Germany.Department of Urology, Kaiser-Franz-Josef-Spital, Vienna, Austria.alta uro AG, Basel, Switzerland, University Basel,Basel, Switzerland.Taunton & Somerset Hospital, Taunton, UK.Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada.Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece. Electronic address: mamoulak@uoc.gr.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30773327

Citation

Karavitakis, Markos, et al. "Management of Urinary Retention in Patients With Benign Prostatic Obstruction: a Systematic Review and Meta-analysis." European Urology, vol. 75, no. 5, 2019, pp. 788-798.
Karavitakis M, Kyriazis I, Omar MI, et al. Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. Eur Urol. 2019;75(5):788-798.
Karavitakis, M., Kyriazis, I., Omar, M. I., Gravas, S., Cornu, J. N., Drake, M. J., Gacci, M., Gratzke, C., Herrmann, T. R. W., Madersbacher, S., Rieken, M., Speakman, M. J., Tikkinen, K. A. O., Yuan, Y., & Mamoulakis, C. (2019). Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. European Urology, 75(5), 788-798. https://doi.org/10.1016/j.eururo.2019.01.046
Karavitakis M, et al. Management of Urinary Retention in Patients With Benign Prostatic Obstruction: a Systematic Review and Meta-analysis. Eur Urol. 2019;75(5):788-798. PubMed PMID: 30773327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. AU - Karavitakis,Markos, AU - Kyriazis,Iason, AU - Omar,Muhammad Imran, AU - Gravas,Stavros, AU - Cornu,Jean-Nicolas, AU - Drake,Marcus J, AU - Gacci,Mauro, AU - Gratzke,Christian, AU - Herrmann,Thomas R W, AU - Madersbacher,Stephan, AU - Rieken,Malte, AU - Speakman,Mark J, AU - Tikkinen,Kari A O, AU - Yuan,Yuhong, AU - Mamoulakis,Charalampos, Y1 - 2019/02/14/ PY - 2018/10/22/received PY - 2019/01/29/accepted PY - 2019/2/19/pubmed PY - 2019/2/19/medline PY - 2019/2/19/entrez KW - Benign prostatic obstruction KW - Meta-analysis KW - Prostate KW - Randomized controlled trial KW - Treatment outcome KW - Urinary retention SP - 788 EP - 798 JF - European urology JO - Eur. Urol. VL - 75 IS - 5 N2 - CONTEXT: Practice patterns for the management of urinary retention (UR) secondary to benign prostatic obstruction (BPO; UR/BPO) vary widely and remain unstandardized. OBJECTIVE: To review the evidence for managing patients with UR/BPO with pharmacological and nonpharmacological treatments included in the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms. EVIDENCE ACQUISITION: Search was conducted up to April 22, 2018, using CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. This systematic review included randomized controlled trials (RCTs) and prospective comparative studies. Methods as detailed in the Cochrane handbook were followed. Certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. EVIDENCE SYNTHESIS: Literature search identified 2074 citations. Twenty-one studies were included (qualitative synthesis). The evidence for managing patients with UR/BPO with pharmacological or nonpharmacological treatments is limited. CoE for most outcomes was low/very low. Only α1-blockers (alfuzosin and tamsulosin) have been evaluated in more than one RCT. Pooled results indicated that α1-blockers provided significantly higher rates of successful trial without catheter compared with placebo [alfuzosin: 322/540 (60%) vs 156/400 (39%) (odds ratio {OR} 2.28, 95% confidence interval {CI} 1.55 to 3.36; participants=940; studies=7; I2=41%; low CoE); tamsulosin: 75/158 (47%) vs 40/139 (29%) (OR 2.40, 95% CI 1.29 to 4.45; participants=297; studies=3; I2=30%; low CoE)] with rare adverse events. Similar rates were achieved with tamsulosin or alfuzosin [51/87 (59%) vs 45/84 (54%) (OR 1.28, 95% CI 0.68 to 2.41; participants=171; studies=2; I2=0%; very low CoE)]. Nonpharmacological treatments have been evaluated in RCTs/prospective comparative studies only sporadically. CONCLUSIONS: There is some evidence that usage of α1-blockers (alfuzosin and tamsulosin) may improve resolution of UR/BPO. As most nonpharmacological treatments have not been evaluated in patients with UR/BPO, the evidence is inconclusive about their benefits and harms. PATIENT SUMMARY: There is some evidence that alfuzosin and tamsulosin may increase the rates of successful trial without catheter, but little or no evidence on various nonpharmacological treatment options for managing patients with urinary retention secondary to benign prostatic obstruction. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/30773327/Management_of_Urinary_Retention_in_Patients_with_Benign_Prostatic_Obstruction:_A_Systematic_Review_and_Meta-analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(19)30092-2 DB - PRIME DP - Unbound Medicine ER -