Tamsulosin Versus Placebo to Prevent Postoperative Urinary Retention Following Female Pelvic Reconstructive Surgery: a Multicenter Randomized Controlled Trial.

Postoperative urinary retention is common following female pelvic reconstructive surgery. Alpha receptor antagonists can improve dysfunctional voiding by relaxing the bladder outlet, and may be effective in reducing the risk of postoperative urinary retention.
To determine whether tamsulosin is effective in preventing post-operative urinary retention in women undergoing surgery for pelvic organ prolapse.
This was a multicenter, double-blind, randomized controlled trial between August 2018 and June 2020, including women undergoing surgery for pelvic organ prolapse. Patients were excluded from recruitment if they had elevated preoperative post-void residual volume, history of post-operative urinary retention, or a contraindication to tamsulosin. Those who experienced cystotomy were excluded from analysis. Participants were randomized to a 10-day perioperative course of tamsulosin 0.4mg versus placebo, beginning three days prior to surgery. A standardized voiding trial was performed on postoperative day 1. The primary outcome was development of post-operative urinary retention, as defined by failure of the voiding trial or subsequent need for catheterization to empty the bladder. Secondary outcomes included the rate of urinary tract infection and the impact on lower urinary tract symptoms as measured by the American Urological Association Symptom Index.
Of 119 patients, 57 received tamsulosin and 62 received placebo. Groups were similar in regard to demographics, preoperative prolapse and voiding characteristics, and surgical details. Tamsulosin was associated with a lower rate of post-operative urinary retention compared to placebo (5 patients [8.8%] versus 16 patients [25.8%], OR 0.28, 95%CI 0.09-81, p=0.02). The number needed to treat to prevent one case of post-operative urinary retention was 5.9 patients. Rate of urinary tract infection did not differ between groups. American Urological Association Symptom Index scores significantly improved after surgery in both groups (median total score 14 versus 7, p<0.01). Scores related to urinary stream improved more in the tamsulosin group compared to placebo (p=0.03).
In this placebo-controlled trial, tamsulosin use was associated with a reduced risk of post-operative urinary retention in women undergoing surgery for pelvic organ prolapse.

Copyright © 2021. Published by Elsevier Inc.