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The effect of tamsulosin in postoperative urinary retention: a meta-analysis of randomized controlled trials

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Abstract

Tamsulosin is a therapeutic drug of alpha-adrenergic antagonists. Previous randomized controlled trials and retrospective analyses have proved the efficacy of tamsulosin on many urinary system diseases. However, there is still a conflict about whether tamsulosin could prevent postoperative urinary retention (POUR). This meta-analysis aims to probe into the efficacy of tamsulosin for preventing POUR versus placebo. We searched MEDLINE, EMBASE, and Cochrane Library from December 31, 1999 to April 30, 2022, for randomized controlled trials (RCTs). Studies that were not RCTs or without negative controls were excluded. Cochrane Collaboration harmonized criteria were used to assess the risk of bias in included studies. Revman (version 5.3) software was invited to synthesize the results. We performed subgroup analyses to explore the factors that could influence tamsulosin’s efficacy in POUR prevention. Our meta-analysis pooled 13 RCTs with 2163 patients. We concluded that tamsulosin brought about a significant reduction in the risk of POUR versus placebo (13.54% vs 20.88% for tamsulosin vs placebo, RR = 0.63, 95% CI 0.47 to 0.84, P = 0.002). Tamsulosin could significantly reduce the risk of POUR in abdominal (11.52% vs 20.25% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.88, P = 0.02) and female pelvic surgery (15.57% vs 31.50% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.82, P = 0.006) but not in spinal surgery (13.45% vs 12.75% for tamsulosin vs placebo, RR = 1.07, 95% CI 0.72 to 1.60, P = 0.73) and lower limb surgery (21.43% vs 33.33% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.35 to 1.14, P = 0.13). The preventive effect of postoperative (17.70% vs 33.93% for tamsulosin vs placebo, RR = 0.53, 95% CI 0.33 to 0.85, P = 0.008) and postoperative with preoperative tamsulosin (13.96% vs 23.44% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.43 to 0.93, P = 0.02) on POUR were significantly better than preoperative management (11.95% vs 14.63% for tamsulosin vs placebo, RR = 0.62, 95% CI 0.23 to 1.65, P = 0.34). Postoperative catheter placement appears to have a negative impact on the POUR-preventive effect of tamsulosin. (9.37% vs 16.46% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.83, P = 0.007) Tamsulosin showed significantly effect on POUR prevention in patients during spinal (15.07% vs 26.51% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.90, P = 0.02) and epidural anesthesia (12.50% vs 29.79% for tamsulosin vs placebo, RR = 0.42, 95% CI 0.18 to 1.00, P = 0.05) but not in general anesthesia (12.40% vs 18.52% for tamsulosin vs placebo, RR = 0.68, 95% CI 0.45 to 1.03, P = 0.07). Tamsulosin shows better outcomes for preventing POUR than placebo. Besides, tamsulosin showed a different effect on POUR prevention in the various surgical sites, anesthesia, medication management, and catheter use. However, our conclusions still have some limitations due to the lack of evidence.

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Funding

This work was supported by the Suzhou Health Talents Training Project (GSWS2019002), the National Natural Science Foundation of China under Grant [82002643]; China Postdoctoral Science Foundation under Grant [2019M651954].

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  1. Bixi Gao and Dingding Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China

    Bixi Gao, Yunjiang Wang, Zongqi Wang & Zhong Wang

  2. Institute of Stroke Research, Soochow University, Suzhou, 215006, China

    Bixi Gao, Yunjiang Wang, Zongqi Wang & Zhong Wang

  3. Department of Anesthesia, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China

    Dingding Zhang

  4. Department of Neurosurgery, Yancheng Third People’s Hospital, Jiangsu Province, Yancheng, 224000, China

    Yunjiang Wang

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Contributions

ZW is the principal investigator. BG and DZ designed the study and developed the analysis plan. BG and ZQW analyzed the data and performed a meta-analysis. BG, DZ, and YW contributed to the writing of the article. ZW and ZQW revised the manuscript and polished the language.

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Correspondence to Zongqi Wang or Zhong Wang.

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Gao, B., Zhang, D., Wang, Y. et al. The effect of tamsulosin in postoperative urinary retention: a meta-analysis of randomized controlled trials. Naunyn-Schmiedeberg's Arch Pharmacol 396, 441–451 (2023). https://doi.org/10.1007/s00210-022-02343-y

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