Alpha-blockers may assist successful catheter removal after acute urinary retention

Clinical question: 
How effective are alpha-blockers in increasing the success rates of trial without a catheter (TWOC) after an episode of acute urinary retention in men?
Bottom line: 
The limited available evidence suggests that, compared to placebo, alpha-blockers increase success rates of TWOC (NNT* 12). Two different alpha-blockers were tested (tamsulosin and alfuzosin). Alpha-blocker side effects were low and comparable to placebo. It is uncertain whether alpha-blockers reduce the risk of recurrent urinary retention and need for prostate surgery. The cost-effectiveness and recommended duration of alpha-blocker treatment after successful TWOC remains unknown. * NNT = number needed to treat to benefit 1 individual
Caveat: 
There is a lack of internationally agreed outcome measures for what constitutes successful TWOC. This makes meta-analysis difficult. Treatment was given for 1 to 3 days (and in 1 study up to a maximum of 8 days) before the catheter was removed.
Context: 
Acute urinary retention is a urological emergency in men and requires urgent catheterisation. Any intervention which increases the rates of successful TWOC following an acute urinary retention episode would be potentially beneficial. Alpha-blockers relax prostatic smooth muscle cells, thereby decreasing the resistance to urinary flow and by doing so improve urinary symptoms.
Review CD#: 
CD006744
PEARLS No: 
246
Date: 
April, 2010
Authored by: 
Brian R McAvoy