Tamsulosin to Prevent Urinary Retention Following Female Pelvic Reconstructive Surgery: A Multicenter Randomized Controlled Trial

Abstract

Study Objective To determine if tamsulosin is effective in reducing the risk of postoperative urinary retention in women undergoing pelvic reconstructive surgery. Design We performed a multicenter double-blind randomized controlled trial. Setting Surgery for pelvic organ prolapse with or without a concomitant incontinence procedure. Patients or Participants All patients undergoing surgery for pelvic organ prolapse from August 2018 to March 2020 at two academic institutions were screened. Patients with a history of urinary retention requiring catheterization, sulfa allergy, or a preoperative post-void residual volume of greater than 100ml were not eligible. Participants who experienced cystotomy were excluded from analysis. A total of 132 patients were enrolled. Interventions Using permuted block randomization, participants were allocated to receive a 10-day course of either tamsulosin 0.4mg or placebo, beginning 3 days prior to surgery. Both patients and providers were blinded to treatment group. A standardized voiding trial was performed on postoperative day one. Measurements and Main Results An intention-to-treat analysis of 118 patients was performed. Patients received either tamsulosin (n=57) or placebo (n=61). Mean age was 61.2 ± 10.2 years, 86.4% were Caucasian, and 71.2% had stage 2 or 3 prolapse. Procedures included vaginal prolapse repair in 85.6%, abdominal prolapse repair in 49.2%, hysterectomy in 66.9%, and midurethral sling in 60.2%. Groups were similar in regards to demographics, pelvic organ prolapse quantification scores, baseline urinary symptoms, urodynamic parameters, and surgical details. Tamsulosin users had a significantly lower rate of urinary retention compared to placebo (8.7% vs 24.6%, p=0.03). Postoperative urinary tract infection and prolonged urinary retention requiring reoperation did not differ between groups. Variables associated with the development of postoperative urinary retention included tamsulosin use (OR 0.29, 95%CI 0.10-0.85) and American Urological Association Symptom Index score (OR 0.90, 95%CI 0.82-0.98). Conclusion This study supports the prophylactic use of tamsulosin to reduce the risk of postoperative urinary retention following female pelvic reconstructive surgery.