One discussion this week involved the use of prophylactic flomax in preventing postoperatuve urinary retention (POUR).

Reference: Ghuman A, et al. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. American Journal of Surgery. 2018 May;215(5):973-979. doi: 10.1016/j.amjsurg.2018.01.015. Epub 2018 Feb 3.

Summary: With an increase in outpatient and fast-track surgical procedures, urethral catheterization is used less commonly thus increasing the likelihood of POUR. Urethral catheterization, a mainstay of initial management for patients with POUR, can
be associated with prolonged length of hospital stay and complications, such as urinary tract infections that may increase cost of care.

Ghuman et al (2017) analyzed 15 RCTs, (1732 patients) and found that prophylactic alpha-1 adrenergic blockers significantly reduced risk of POUR, without a statistically significant increase in adverse events.

Urinary retention: There were 370 episodes of urinary retention among the 1732 patients. There were 119 episodes of urinary retention amongst 904 patients who received alpha-1 adrenergic blockers. There were 251 episodes of urinary retention amongst the 830 control patients.

Adverse events: Adverse events, which ranged from postural hypotension, headache, dizziness, vomiting, ileus, anastomotic leak and chylous ascites, were reported in 10 studies. There were 92 reported adverse events, 43 in the control groups and 49 in the alpha-1 adrenergic blocker groups. There was no statistically significant effect of alpha-1 adrenergic blockers on reported adverse events.

Subgroup analysis revealed strong risk reduction and little heterogeneity in males and patients receiving spinal anesthesia. In conclusion, prophylactic alpha-1 adrenergic blockers reduce risk of POUR in males and after spinal anesthesia.

Additional reading: Chapman BC, et al. Perioperative and Survival Outcomes Following Neoadjuvant FOLFIRINOX versus Gemcitabine Abraxane in Patients with Pancreatic Adenocarcinoma.  JOP: Journal of the Pancreas. 2018 Mar;19(2):75-85. Epub 2018 Mar 30