Incidence Of Acute Urinary Retention Research Articles

Tolterodine Extended Release With or Without Tamsulosin in Men With Lower Urinary Tract Symptoms Including Overactive Bladder Symptoms: Effects of Prostate Size

BackgroundSome men with lower urinary tract symptoms (LUTS) including overactive bladder (OAB) symptoms may benefit from antimuscarinic therapy, with or without an α-adrenergic antagonist. ObjectivesTo evaluate the safety and efficacy of tolterodine extended release (ER), tamsulosin, or tolterodine ER+tamsulosin in men meeting symptom entry criteria for OAB and prostatic enlargement trials, stratified by prostate size. Design, setting, and participantsSubjects with an International Prostate Symptom Score (IPSS) ≥12; frequency and urgency, with or without urgency urinary incontinence; postvoid residual volume (PVR) <200mL; and maximum urinary flow rate (Qmax) >5mL/s were randomized to receive placebo, tolterodine ER (4mg), tamsulosin (0.4mg), or tolterodine ER+tamsulosin for 12 wk. Data were stratified by median baseline prostate volume (<29mL vs ≥29mL). MeasurementsEndpoints included week 12 changes in bladder diary variables, IPSS scores, and safety variables. Results and limitationsAmong men with larger prostates, tolterodine ER+tamsulosin significantly improved frequency (p=0.001); urgency (p=0.006); and IPSS total (p=0.001), storage (p<0.001), and voiding scores (p<0.013). Tamsulosin significantly improved IPSS voiding scores (p=0.030). Among men with smaller prostates, tolterodine ER significantly improved frequency (p=0.016), UUI episodes (p=0.036), and IPSS storage scores (p=0.005). Tolterodine ER+tamsulosin significantly improved frequency (p=0.001) and IPSS storage scores (p=0.018). Tamsulosin significantly improved nocturnal frequency (p=0.038) and IPSS voiding (p=0.036) and total scores (p=0.044). There were no clinically or statistically significant changes in Qmax or PVR; incidence of acute urinary retention (AUR) was low in all groups (≤2%). ConclusionsMen with smaller prostates and moderate-to-severe LUTS including OAB symptoms benefited from tolterodine ER. Therapy with tolterodine ER+tamsulosin was effective regardless of prostate size. Tolterodine ER, with or without tamsulosin, was well tolerated and not associated with increased incidence of AUR.

Does anticholinergic medication have a role in treating men with overactive bladder and benign prostatic hyperplasia?

This review discusses the available evidence concerning the use of anticholinergic drugs, alone or in combination with alpha-adrenoceptor antagonists, in men with lower urinary tract symptoms due to benign prostatic hyperplasia, benign prostatic enlargement, or benign prostatic obstruction and concomitant overactive bladder syndrome. We emphasize the safety and efficacy of anticholinergic agents in treating men with benign prostatic obstruction. Several recent studies of men with an overactive bladder suggest that combination therapy of anticholinergic and alpha-adrenoceptor antagonists improves the symptoms effectively without increasing the incidence of acute urinary retention.

New Data on Tolterodine: Do Recent Findings Dispel Questions About Treating Overactive Bladder in Men?

Overactive bladder (OAB) is a syndrome characterized by urinary urgency, with or without urgency urinary incontinence (UUI), usually with frequency and nocturia. These symptoms represent a subset of lower urinary tract symptoms (LUTS). Results from epidemiologic studies conducted in the United States and Europe suggest that OAB affects 11–16% of men. Although OAB is frequently associated with detrusor overactivity, the coexistence of OAB symptoms and prostatic conditions (e.g., benign prostatic hyperplasia, benign enlargement of the prostate, and bladder outlet obstruction [BOO]) in men adds complexity to the diagnosis and appropriate treatment. Men with OAB symptoms are more often prescribed pharmacotherapies that target the prostate (e.g., α-receptor antagonists, 5α-reductase inhibitors) rather than the bladder (e.g., antimuscarinics), possibly due to a tendency among clinicians to attribute all LUTS to prostate disease. Thus, a subset of men who receive treatment for prostatic conditions may have persistent OAB symptoms. Moreover, some physicians may be concerned that the inhibitory effect of antimuscarinic agents on detrusor contraction could aggravate the voiding difficulties of, or cause urinary retention in, men with OAB and possible BOO. Recent prospective studies and post hoc analyses of data from men with OAB symptoms and other LUTS, with or without concomitant BOO (not significant BOO at risk for urinary retention), have suggested that tolterodine improves OAB symptoms without an increased incidence of acute urinary retention. However, the literature would benefit from larger and longer placebo-controlled studies.

Tolterodine and Tamsulosin for Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder

Men with overactive bladder and other lower urinary tract symptoms may not respond to monotherapy with antimuscarinic agents or alpha-receptor antagonists. To evaluate the efficacy and safety of tolterodine extended release (ER), tamsulosin, or both in men who met research criteria for both overactive bladder and benign prostatic hyperplasia. Randomized, double-blind, placebo-controlled trial conducted at 95 urology clinics in the United States involving men 40 years or older who had a total International Prostate Symptom Score of 12 or higher and, an International Prostate Symptom Score quality-of-life (QOL) item score of 3 or higher, a self-rated bladder condition of at least moderate bother, and a bladder diary documenting micturition frequency (>or=8 micturitions per 24 hours) and urgency (>or=3 episodes per 24 hours), with or without urgency urinary incontinence. Patients were recruited between November 2004 and February 2006, and the study was completed May 2006. Patients were randomly assigned to receive placebo (n = 222), 4 mg of tolterodine ER (n = 217), 0.4 mg of tamsulosin (n = 215), or both tolterodine ER plus tamsulosin (n = 225) for 12 weeks. Patient perception of treatment benefit, bladder diary variables, International Prostate Symptom Scores, and safety and tolerability were assessed. A total of 172 men (80%) receiving tolterodine ER plus tamsulosin reported treatment benefit by week 12 compared with 132 patients (62%) receiving placebo (P<.001), 146 (71%) receiving tamsulosin (P=.06 vs placebo), or 135 (65%) receiving tolterodine ER (P=.48 vs placebo). Patients receiving tolterodine ER plus tamsulosin compared with placebo experienced significant reductions in urgency urinary incontinence (-0.88 vs -0.31, P=.005), urgency episodes without incontinence (-3.33 vs -2.54, P=.03), micturitions per 24 hours (-2.54 vs -1.41, P<.001), and micturitions per night (-0.59 vs -0.39, P.02). Patients receiving tolterodine ER plus tamsulosin demonstrated significant improvements on the total International Prostate Symptom Score (-8.02 vs placebo, -6.19, P=.003) and QOL item (-1.61 vs -1.17, P=.003). All interventions were well tolerated. The incidence of acute urinary retention requiring catheterization was low (tolterodine ER plus tamsulosin, 0.4%; tolterodine ER, 0.5%; tamsulosin, 0%; and placebo, 0%). These results suggest that treatment with tolterodine ER plus tamsulosin for 12 weeks provides benefit for men with moderate to severe lower urinary tract symptoms including overactive bladder. Clinical Trials Registration clinicaltrials.gov Identifier: NCT00147654.

Long-term results of medical treatment in benign prostatic hyperplasia

Objectives In real-life clinical practice, we determined the incidence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH)-related surgery in patients with BPH who received alpha-adrenergic receptor blocker (α-blocker) and/or 5-alpha-reductase inhibitor combination treatment. Methods This retrospective study enrolled 341 patients with BPH who were prescribed an α-blocker and/or a 5-alpha-reductase inhibitor as their first treatment from January 1997 to June 1999. Using follow-up data from a 6 to 8-year period, we calculated the incidence of AUR and BPH-related surgery in the α-blocker-only group and in the combination group. Results Of the 341 patients, 192 were in the α-blocker group and 149 were in the combination group. Of these, 17.7% in the α-blocker group and 12.1% in the combination group experienced AUR ( P <0.05). BPH-related surgery was performed in 10.9% of the α-blocker-only group and 6.0% of the combination group ( P <0.05). The incidence of AUR and BPH-related surgery was reduced by 32.3% and 48.9% when the prostate volume was larger than 35 g and by 49.4% and 60.6% when the prostate-specific antigen level was greater than 2.0 ng/mL, respectively, in the combination group compared with the corresponding values in the α-blocker group. Conclusions Real-life clinical practice showed that long-term combination treatment with α-blockers and 5-alpha-reductase inhibitors reduced the risk of BPH progression, such as AUR or BPH-related surgery, compared with α-blocker-only treatment.

Response to Daily 10 Mg Alfuzosin Predicts Acute Urinary Retention and Benign Prostatic Hyperplasia Related Surgery in Men With Lower Urinary Tract Symptoms

We analyzed the influence of treatment response on the risk of acute urinary retention and benign prostatic hyperplasia related surgery in 5,792 men complaining of lower urinary tract symptoms who were treated for 6 months with the selective alpha1-blocker alfuzosin at 10 mg once daily. The influence of dynamic variables (International Prostate Symptom Score change and bother during treatment) and baseline variables (patient age, prior acute urinary retention managed conservatively, prostate specific antigen, International Prostate Symptom Score and bother severity) on the risk of acute urinary retention and benign prostatic hyperplasia related surgery was estimated using the Kaplan-Meier method and log rank test. The associated HR and 95% CI were calculated using Cox proportional hazard models. During alfuzosin treatment International Prostate Symptom Score improved by 3 or greater and greater than 6 points in 74.8% and 50.3% of men, respectively. In this unselected population, including 3.8% with prior unoperated acute urinary retention, the rate of acute urinary retention and benign prostatic hyperplasia related surgery events during treatment was low (0.5% and 1.1%, respectively). Men with stable or worsening International Prostate Symptom Score were at increased risk for acute urinary retention or surgery (HR 3.75, 95% CI 1.58 to 8.89, p = 0.003 and HR 4.71, 95% CI 2.69 to 8.24, p <0.001, respectively). Prior acute urinary retention was a strong predictor of acute urinary retention relapse and surgery (HR 10.35, 95% CI 4.29 to 26.08, p <0.001 and HR 3.57, 95% CI 1.59 to 7.98, p = 0.002, respectively). Bother score greater than 3 during treatment was the strongest predictor of surgery (HR 7.61, 95% CI 4.16 to 13.93, p <0.001). Prostate specific antigen had much less predictive value. This 6-month real life practice study shows that alfuzosin is associated with a low incidence of acute urinary retention and benign prostatic hyperplasia related surgery. It also suggests that responder status is the most important predictor of acute urinary retention and benign prostatic hyperplasia related surgery. Thus, first line treatment with alfuzosin may help select patients at risk for benign prostatic hyperplasia progression to optimize treatment.

Incidence of Primary and Recurrent Acute Urinary Retention Between 1998 and 2003 in England

We report how the incidence of primary and recurrent acute urinary retention changed in England between 1998 and 2003. In addition, we present data on changes with time in the use of prostatectomy after acute urinary retention and recurrent acute urinary retention. Data were extracted from the Hospital Episode Statistics database of the Department of Health in England. Patients were included in the study if an International Classification of Diseases, Tenth Revision code for acute urinary retention or an operative procedure code for transurethral prostate resection was present in any diagnosis or procedure fields of the Hospital Episode Statistics database. A total of 165,527 men were identified to have been hospitalized with acute urinary retention in the study period. The incidence of primary acute urinary retention was 3.06/1,000 men yearly. Acute urinary retention was spontaneous in 65.3% of cases. The incidence of acute urinary retention decreased from 3.17/1,000 men yearly in 1998 to 2.96/1,000 yearly in 2003. Surgical treatment following spontaneous acute urinary retention decreased 20% from 32% in 1998 to 26% in 2003. This trend coincided with a 20% increase in the rate of recurrent acute urinary retention. The slight decrease in the incidence of primary acute urinary retention suggests that the shift away from surgical treatment for benign prostatic hyperplasia has not resulted in an increase in acute urinary retention. The increase in recurrent acute urinary retention suggests that the observed decrease in surgery after acute urinary retention may have put more men at risk for acute urinary retention recurrence.

Dutasteride: A Dual 5-α Reductase Inhibitor for the Treatment of Symptomatic Benign Prostatic Hyperplasia

To review the pharmacology, pharmacokinetics, efficacy, safety, drug interactions, and dosing recommendations of dutasteride, a 5-alpha reductase inhibitor for benign prostatic hyperplasia (BPH). A MEDLINE search (1966-February 2006) was conducted to extract human research data in the English language on dutasteride. Search terms included benign prostatic hyperplasia, dutasteride, and finasteride. The reference lists of articles identified through this search process, the manufacturer's Web site, and dutasteride prescribing information were also examined. All published studies and clinical data from the manufacturer were included, with emphasis placed on randomized, controlled trials. Dutasteride is approved for the treatment of symptomatic BPH in men with an enlarged prostate to improve urinary symptoms, reduce the risk of acute urinary retention, and reduce the need for BPH-related surgical interventions. Compared with placebo, dutasteride has been shown to significantly improve BPH symptoms, reduce the incidence of acute urinary retention and BPH-related surgery, and improve BPH-related quality of life. Few published data exist comparing dutasteride with finasteride. The most common adverse effects of dutasteride include ear, nose, and throat infection; malaise; headache; dizziness; and musculoskeletal pain. Clinical trials, sponsored primarily by the manufacturer, have shown dutasteride to be an effective treatment of BPH compared with placebo and to likely possess efficacy similar to that of finasteride. Further studies are needed to gain a more clear understanding of any clinically significant differences between dutasteride and finasteride.

To what extent do real life practice studies differ from randomized controlled trials in lower urinary tract symptoms/benign prostatic hyperplasia?

To compare the real-life practice studies and randomized controlled trials on benign prostatic hyperplasia in order to understand the applications of the data from the two types of study. Until recently, much of the available information on benign prostatic hyperplasia has come from randomized controlled trials conducted by secondary care urologists on selected populations of patients, who are likely to represent the more symptomatic among the cohort of men with lower urinary tract symptoms in the community. The strict inclusion criteria in these trials led to uncertainty about the applicability of the results to community populations. Moreover, as patients in randomized controlled trials are specially recruited, rather than being drawn from a general population of men with lower urinary tract symptoms, the calculations of incidence and prevalence rates may not be possible. In the last few years, there have been a few important real-life practice studies such as the Triumph project, the Quadraet study and the ALF-ONE study, which have provided very useful data regarding the incidence and prevalence of lower urinary tract symptoms/benign prostatic hyperplasia, the incidence of acute urinary retention, the impact of therapy on the risk of surgery related to benign prostatic hyperplasia and the predictors of disease progression during treatment with alpha-blocker. As the results from randomized controlled trials cannot always be generalized to daily urological practice, it is important to complement them with data made available by the real-life practice studies. In order to do that, the salient features in the methodology of both types of study must be understood.

Rebuttal to Dr. Stock

One must remember that most patients are treated in smaller community hospitals. These low-volume centers may have difficulty consistently achieving high-quality LDR implants regardless of the technique used. Suboptimal LDR implants result in higher biochemical failure rates (2). However, with HDR’s postneedle placement CT planning one can usually correct for suboptimal needle placement and consistently achieve high-quality dosimetry (3). In terms of patient convenience LDR wins. But the two nights in the hospital needed for HDR monotherapy certainly compare favorably with radical prostatectomy or 8 weeks of daily external beam radiation therapy. The issue that patients are most concerned about is toxicity. I do not think we can assume that HDR is superior to LDR in terms of impotency based on the one study from William Beaumont, but this study is intriguing. Rectal toxicity is very low with both LDR and HDR patients, so proctitis will not be a deciding toxicity factor either. Acute urinary side effects are higher in the LDR patients, as noted in the study by Gillis that directly and prospectively compared healthrelated quality of life in HDR monotherapy and LDR monotherapy patients. HDR patients have a significantly lower incidence of acute urinary retention and dysuria than LDR patients, and in my experience less urge incontinence the first few weeks after implant. Thus, at this point in time, HDR monotherapy seems promising in terms of both efficacy and toxicity. More confirmatory studies with longer followup need to be reported before HDR monotherapy will be generally accepted as an alternative to LDR monotherapy outside a study setting.

The impact of medical therapy on surgery for benign prostatic hyperplasia: a study comparing changes in a decade (1992–2002)

To compare the clinical profile (age, comorbidities, symptom severity, and incidence of acute urinary retention, AUR), the type and duration of medical treatment, and indications for surgery of patients undergoing surgery for benign prostatic hyperplasia (BPH) in 1992 and 2002 at one centre. In this single-centre, retrospective, cross-sectional observational study, the medical history of all patients who had surgery for BPH in the first semester of 1992 (85) and 2002 (70) was reviewed. The preoperative clinical profile was determined by assessing age, main comorbidities, prostatic volume, maximum urinary flow rate and symptom severity. The type and duration of pharmacology for BPH was evaluated from the medical history and telephone contact with the patients. Indications for surgery, the method of operation and the weight of removed tissue (open adenectomy) or the volume of the resected tissue (transurethral resection) were obtained from the patients' records and compared. Surgical complications in both groups were assessed, as was the average stay in hospital. In our institution, surgery for BPH decreased by 17.6% in the decade, with patients having surgery when older, at a mean (sd) of 69.1 (8.57) vs 72.3 (7.59) years, i.e. 3.1 years older (P = 0.028), but with similar comorbidities. Reasons for surgery in 1992/2002, respectively, were AUR in 41/37%, and symptoms worsening in 48/51%. The few cases of haematuria and bladder stone were similarly distributed in both groups. Pharmacology for BPH was prescribed in 46% of patients in 1992, phytotherapy being the most common (89%), whereas in 2002, 82% (P < 0.01) were treated, most of them with alpha-adrenergic antagonists (79%). Open surgery was indicated in 18.8% of patients in 1992 (mean adenoma weight 73.8 g, sd 37.12) and in 28.6% in 2002 (79.8 g, sd 35.41; P = 0.625). The mean (sd) hospital stay was 8.9 (4.06) vs 5.0 (1.22) days in 1992 and 2002, respectively (P < 0.01) for transurethral resection, and 14.1 (5.74) vs 8.7 (4.83) for open adenectomy (P = 0.013). The complication rate was similar for both groups. Compared with 1992, fewer patients with BPH have surgery, when older and after receiving medical treatment for longer. The indications for surgery are similar. Significantly more patients had open surgery, perhaps because the progressive increase in prostate volume was not affected by the medical therapy used predominantly during this decade.

LONG-TERM EFFECTS OF FINASTERIDE ON PROSTATE SPECIFIC ANTIGEN LEVELS: RESULTS FROM THE PROSTATE CANCER PREVENTION TRIAL

Studies have shown that finasteride decreases prostate specific antigen (PSA) by approximately 50% during the first 12 months of use. We estimated the long-term effects of finasteride on PSA in men with and without a prostate cancer diagnosis at the end of the study. We analyzed serial PSA in participants in the Prostate Cancer Prevention Trial who had an end of study biopsy (928 with cancer and 8,620 with negative biopsy) or an interim diagnosis of prostate cancer (671). Linear mixed effects regression models were fit to longitudinal PSA values beginning 1 year after randomization. In subjects with no cancer in the end of study biopsy PSA in the finasteride arm showed a median annual decrease of 2% [corrected] after year 1, while PSA in the control arm showed an annual increase of 3% (p <0.001). In end of study cases PSA increased annually by 6% (placebo) and 7% (finasteride). In those with interim diagnoses PSA increased by 11% (placebo) and 15% (finasteride) each year prior to diagnosis. Cases with high grade disease (Gleason 7 and above) had greater PSA increases than cases with low grade disease (p <0.001). In men who have been receiving finasteride for more than 1 year time varying adjustment factors may be needed to determine whether PSA is in the normal range. In the Prostate Cancer Prevention Trial cohort the adjustment factor required to preserve median PSA increased from 2 at 24 months to 2.5 at 7 years after the initiation of finasteride.

Combination Therapy for the Pharmacological Management of Benign Prostatic Hyperplasia

The management of symptomatic benign prostatic hyperplasia (BPH) continues to evolve, with new techniques and forms of medical management being introduced and traditional surgical techniques being used less frequently. Medical management of BPH has evolved from nonspecific alpha-adrenoceptor antagonists to uroselective alpha-adrenoceptor antagonists and 5-alpha reductase inhibitors. Traditionally, alpha-adrenoceptor antagonists have been used for relief of lower urinary tract symptoms (LUTS) as a result of BPH and are known for their quick onset of action. 5-alpha Reductase inhibitors have proven useful for the prevention of BPH progression as measured by prostate volume, disease progression, incidence of acute urinary retention and the need for subsequent BPH-related surgery. Recent studies have shown that the combination of an alpha-adrenoceptor antagonist and a 5-alpha reductase inhibitor has significantly better efficacy than either drug alone or placebo. Currently, alpha-adrenoceptor antagonists are used in the acute setting or for short-term relief of LUTS. The combination of an alpha-adrenoceptor antagonist and a 5-alpha reductase inhibitor is used for the longer term management of BPH symptoms and to prevent progression of BPH and perhaps avoid surgical intervention.

Low Incidence of Acute Urinary Retention in the General Male Population: The Triumph Project

Objective: To describe the incidence of acute urinary retention (AUR) in the general male population and in a population of men newly diagnosed with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). Methods: We performed a retrospective cohort study in the Integrated Primary Care Information (IPCI) database, a GP research database in The Netherlands, during the period 1995–2000. All males, ≥45 years, without a history of AUR or radical cystectomy were included in the study. In addition, we followed a sub-cohort of men, newly diagnosed with LUTS/BPH. AUR was defined as the sudden inability to urinate, requiring catheterization. Results: Amongst 56,958 males with a mean follow-up of 2.8 years, 344 AUR cases occurred (incidence rate 2.2/1000 man-years) of whom more than 40% were precipitated. AUR was the first symptom of LUTS/BPH in 73 (49%) of the 149 AUR cases that occurred in men newly diagnosed with LUTS/BPH. The risk of AUR was 11-fold higher in patients newly diagnosed with LUTS/BPH (RR 11.5; 95%CI: 8.4–15.6) with an overall incidence rate of 18.3/1000 man-years (95%CI: 14.5–22.8). Conclusions: The incidence rate of AUR is low in the general population but substantial in a population of men newly diagnosed with LUTS/BPH. The incidence rate increases with age and AUR is precipitated in approximately 40% of all cases. Within the LUTS/BPH cohort, AUR is the first presenting symptom of BPH in 50% of all AUR cases.

Factors predicting for urinary morbidity following 125iodine transperineal prostate brachytherapy

Purpose To assess factors related to the risk of acute urinary retention and other morbidity indices in patients undergoing transperineal seed implantation of the prostate. Materials and methods One hundred and seventy-three consecutive patients treated with 125Iodine transperineal interstitial permanent prostate brachytherapy (TIPPB) were evaluated. Various demographic, pathological, symptomatic, urodynamic and dosimetric values were assessed in relation to the incidence of acute urinary retention as well as the International Prostate Symptom Score (IPSS) dynamics. Patients were routinely placed on α-blockade postimplant. Dosimetry was based on CT scan one month postimplant. Results Acute urinary retention developed in thirty-four patients (19.7%), at a median time of four days. Peak urinary flow rate was the only independent factor which varied significantly between those suffering retention and those not (median of 16 and 19.5 ml/s respectively, P=0.005). Median preimplant IPSS was 4.0, with a median peak of 16 at 3 months. Actuarial median time to return to baseline IPSS was at 15 months. The peak IPSS above preimplant levels was correlated significantly in multivariate analysis with the number of seeds implanted superior to the physician-nominated anatomical base level of the prostate ( P<0.009), as well as lower preimplant IPSS values. Conclusions In our series, preimplant urinary flow rate was the most important factor predictive of postimplant acute urinary retention. The patients' risk of having heightened IPSS change following implantation was correlated to a lower preimplant IPSS and an increased number of seeds implanted above the level of the prostatic base, possibly reflecting bladder base rather than urethral irritation in the development of acute urinary morbidity.

Sustained Decrease in Incidence of Acute Urinary Retention and Surgery With Finasteride for 6 Years in Men With Benign Prostatic Hyperplasia

We determined the effect of long-term treatment with finasteride on the incidence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH) related surgery in men with BPH. The Proscar (Merck and Co., Inc., Whitehouse Station, New Jersey) Long-Term Efficacy and Safety Study (PLESS) was comprised of 3040 men with enlarged prostates, moderate to severe symptomatic BPH and no clinical evidence of prostate cancer. Patients were randomized to placebo or 5 mg finasteride daily for 4 years. Of the 3016 randomized patients with available efficacy data 62% completed the original 4-year study (1006 on finasteride and 891 on placebo) and 89% of these (908 from the original finasteride arm and 785 from the placebo arm) continued in a 2-year open extension on finasteride. Followup was attempted in discontinued patients. Complete 6-year outcomes data, including 6-year followup in 770 men who had discontinued treatment during years 1 to 6, were available for 2463 (82%) of the 3016 originally randomized patients. For patients on continuous finasteride treatment the decrease in incidence of AUR and/or BPH related surgery in the 4-year base study was sustained during the open extension. In patients who were switched from placebo to finasteride in the extension, the incidence of AUR and/or BPH related surgery was similar to that in the continuous finasteride arm. The 6-year data from PLESS confirmed and further extended the findings from the original 4-year trial, demonstrating that finasteride treatment led to a sustained decrease in the incidence of AUR and/or BPH related surgery in men with BPH and enlarged prostates.

146 Incidence of acute urinary retention in the general male population and in men with lower urinary tract symptoms/benign prostatic hyperplasia - the triumph project

146 Incidence of acute urinary retention in the general male population and in men with lower urinary tract symptoms/benign prostatic hyperplasia - the triumph project

The Management of Prostatic Obstruction: How to Determine the Best Options?

The two drug types commonly used to treat symptoms of benign prostatic hyperplasia (BPH), 5α-reductase inhibitors and α 1-blockers, have been shown to have different long-term effects on outcomes such as incidence of acute urinary retention (AUR) and BPH-related surgery. In addition, a comparative study of α 1-blockers and 5α-reductase inhibitors in men with lower urinary tract symptoms showed that the treatment discontinuation rate is higher with α 1-blockers. The risk of treatment failure with α 1-blocker therapy has been shown to be related to baseline prostate volume, with greater failure rates with larger prostate sizes. Clinical data are now available on the dual 5α-reductase inhibitor, dutasteride. Three 2-year phase III randomised, double-blind, placebo-controlled studies have been performed in 4325 men with lower urinary tract symptoms, prostatic enlargement and likely bladder outlet obstruction due to BPH. Compared with placebo, dutasteride significantly improved symptoms from 6 months onwards ( p<0.001). Q max improved significantly in dutasteride-treated patients from 1 month, and dutasteride treatment reduced the risk of AUR by 57% and the risk of BPH-related surgical intervention by 48% compared with placebo. Prostate volume was reduced by a mean of 25.9% and 28.5% at 1 and 2 years, respectively, in dutasteride-treated patients. The most common drug-related adverse events for dutasteride vs. placebo were erectile dysfunction (7% vs. 4%), decreased libido (4% vs. 2%), ejaculation disorders (2% vs. <1%) and gynaecomastia (2% vs. <1%). Adverse events occurred mostly in the first 6 months and their occurrence diminished with time.

9 A declining incidence of Acute Urinary Retention (AUR) following 125-lodine brachytherapy for prostate cancer: the effect of learning curve?

9 A declining incidence of Acute Urinary Retention (AUR) following 125-lodine brachytherapy for prostate cancer: the effect of learning curve?

Tamsulosin reduces the incidence of acute urinary retention following early removal of the urinary catheter after radical retropubic prostatectomy

Objectives To determine the efficacy of tamsulosin in preventing acute urinary retention following early catheter removal after radical retropubic prostatectomy. Methods Between February 2000 and October 2000, cystography was performed on postoperative day 7 after radical retropubic prostatectomy by a single surgeon (group 1). Between September 2001 and August 2002, cystography was performed on postoperative day 8 after radical retropubic prostatectomy by the same surgeon (group 2). The protocol for performing cystography and assessment of extravasation was similar for both groups. Tamsulosin 0.4 mg was administered 3 days before and 4 days after cystography for all men in group 2. Results Of 179 cystograms in group 1, 135 (75%) revealed no extravasation, and the catheters were removed in 130 of these cases. Of 246 cystograms in group 2, 230 (93.5%) revealed no extravasation, and the catheters were removed in 229 of these cases. A significantly greater proportion of men in group 2 had no extravasation ( P = 0.0007). The incidence of acute urinary retention in groups 1 and 2 was 10% and 2.6%, respectively ( P = 0.0018). The incidence of anastomotic stricture was not significantly different between the two groups. Conclusions Our data strongly suggest that tamsulosin significantly reduces the risk of acute urinary retention after attempts at early catheter removal following radical retropubic prostatectomy. Therefore, we recommend administering a 7-day course of tamsulosin therapy when attempting to remove the urinary catheter before postoperative day 8.