Urology Residency Directors' Awareness of Association between α-Adrenergic Antagonists and Floppy Iris Syndrome and Practice Patterns Regarding Prophylactic α-Adrenergic Antagonists

Abstract

Purpose The use of prophylactic α-adrenergic receptor antagonists prior to surgery is associated with reduced postoperative urinary retention. However, α-adrenergic receptor antagonists have been associated with intraoperative floppy iris syndrome (IFIS). Studies have shown that IFIS is correlated with higher rates of cataract surgery complications. The purpose of this study is to investigate United States urology residency program directors' (1) awareness of the association between α-adrenergic receptor antagonists and IFIS and (2) practice patterns regarding the use of prophylactic α-adrenergic receptor antagonists prior to surgery. Materials and Methods An anonymous, online survey was sent to the program director of each of the 138 urology residency programs accredited by the Accreditation Council for Graduate Medical Education. The survey assessed program directors' knowledge regarding the association between α-adrenergic receptor antagonists and IFIS, and practice patterns regarding the use of prophylactic α-adrenergic receptor antagonists prior to surgery. Results Sixty-nine of the 138 (50%) residency directors responded. Forty percent of respondents believe that tamsulosin (Flomax) does not increase the risk of IFIS. Fifty-two percent of respondents prescribe or consider prescribing prophylactic α-adrenergic blockers prior to surgery, with tamsulosin being the most preferred α-adrenergic blocking agent. Of the prescribing urologists, only 58% counsel most of their patients regarding the association between the prescribed drug and IFIS, 28% never ask patients whether they have had cataract surgery, and 56% would change the drug or dosage used if they learned that a patient had not yet had cataract surgery. Conclusion The results of this study demonstrate the potential to decrease the risk of IFIS through education of urologists regarding the association of α-adrenergic antagonists with IFIS.