Amandeep Ghuman1, S W de Jonge2, Simon D Dryden3, Timothy Feeney4, Daniel H Buitrago5, P Terry Phang6. 1. General Surgery Resident, Department of Surgery, Division of General Surgery, University of British Columbia, 950 West 10th Ave, Vancouver, BC V5Z 1M9, Canada. Electronic address: aghuman@providencehealth.bc.ca. 2. Department of Surgery and Anaesthesiology, Academic Medical Center, The Netherlands. Electronic address: std273@mail.harvard.edu. 3. Department of Cancer and Surgery, St. Mary's Hospital, Imperial College London, UK. Electronic address: sid152@mail.harvard.edu. 4. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: tif419@mail.harvard.edu. 5. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: dbuitrag@bidmc.harvard.edu. 6. Colorectal Surgeon, Department of Surgery, Division of General Surgery, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada. Electronic address: tphang@providencehealth.bc.ca.
Abstract
BACKGROUND: Alpha-1 adrenergic blockers used to treat postoperative urinary retention (POUR) may also have a preventative role. Here we assess the evidence behind their prophylactic use on POUR prevention. STUDY DESIGN: PRISMA guidelines were followed. All studies reviewed for eligibility, data extraction, and risk of bias assessment. Pooled risk ratios with 95% confidence intervals calculated using a random effects model. Heterogeneity assessed using Forest plots, I2 statistic and Chi-squared Cochran's Q-statistic. RESULTS: Fifteen RCTs (1732 patients) included. Prophylactic alpha-1 adrenergic blockers significantly reduced risk of POUR, 13.16% vs 30.24%, RR = 0.48 (95%CI: 0.33; 0.70, p-value = .001), without a statistically significant increase in adverse events. Substantial heterogeneity found between included studies (I2 = 65.49% [95%CI:48.49; 95.01] & Q-statistic 43.46 (p-value<.001)). Subgroup analysis revealed strong risk reduction and little heterogeneity in males (RR:0.33, 95%CI:0.23; 0.47, p-value<.001, I2:10.58) and patients receiving spinal anesthesia (RR:0.26, 95%CI:0.14; 0.46, p-value<.0001, I2 = 0%). CONCLUSION: Prophylactic alpha-1 adrenergic blockers reduce risk of POUR in males and after spinal anesthesia.
BACKGROUND:Alpha-1 adrenergic blockers used to treat postoperative urinary retention (POUR) may also have a preventative role. Here we assess the evidence behind their prophylactic use on POUR prevention. STUDY DESIGN: PRISMA guidelines were followed. All studies reviewed for eligibility, data extraction, and risk of bias assessment. Pooled risk ratios with 95% confidence intervals calculated using a random effects model. Heterogeneity assessed using Forest plots, I2 statistic and Chi-squared Cochran's Q-statistic. RESULTS: Fifteen RCTs (1732 patients) included. Prophylactic alpha-1 adrenergic blockers significantly reduced risk of POUR, 13.16% vs 30.24%, RR = 0.48 (95%CI: 0.33; 0.70, p-value = .001), without a statistically significant increase in adverse events. Substantial heterogeneity found between included studies (I2 = 65.49% [95%CI:48.49; 95.01] & Q-statistic 43.46 (p-value<.001)). Subgroup analysis revealed strong risk reduction and little heterogeneity in males (RR:0.33, 95%CI:0.23; 0.47, p-value<.001, I2:10.58) and patients receiving spinal anesthesia (RR:0.26, 95%CI:0.14; 0.46, p-value<.0001, I2 = 0%). CONCLUSION: Prophylactic alpha-1 adrenergic blockers reduce risk of POUR in males and after spinal anesthesia.
Authors: Amandeep Ghuman; Mark T Dawidek; Manraj S Athwal; Naomi Kasteel; Carl J Brown; Ahmer A Karimuddin; Manoj J Raval; P Terry Phang Journal: Int J Colorectal Dis Date: 2021-10-13 Impact factor: 2.571
Authors: J Jackson; P Davies; N Leggett; M D Nugawela; L J Scott; V Leach; A Richards; A Blacker; P Abrams; J Sharma; J Donovan; P Whiting Journal: BJS Open Date: 2018-11-19