The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men

Euan Fisher; Kesavapillai Subramonian; Muhammad Imran Omar

doi:10.1002/14651858.CD006744.pub3

La función de los alfabloqueantes antes de la retirada de la sonda urinaria para la retención urinaria aguda en los hombres

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Referencias

Referencias de los estudios incluidos en esta revisión

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Agrawal MS, Yadav A, Yadav H, Singh AK, Lavania P, Jaiman R. A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia. Indian Journal of Urology 2009;25(4):474‐8.

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Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM. Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention. European Urology 2002;42(4):323‐32.

Tibung MJB, Tiong HY, Macalalag M, Liew L, Li MK. Alfuzosin XL prior to trial off catheter after acute urinary retention: early results from a randomized, double‐blinded, placebo‐controlled trial. International Journal of Urology 2006;13 Suppl 1:35.

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Referencias de los estudios excluidos de esta revisión

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Joo KJ, Choi JB, Kim YS, Kim H, Park HS, Lee W, et al. Effect of tamsulosin in benign prostatic hyperplasia patients who were treated with spinal anesthesia: preventing the acute urinary retention (Abstract number 294). Proceedings of the 38th Annual Meeting of the International Continence Society (ICS), 2008 Oct 20‐24, Cairo, Egypt. 2008.

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Referencias de los estudios en espera de evaluación

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Perepanova TS, Kamalov AA, Sinyuhin VN, Gorohov AV, Hazan PL, Orlov EV. Doxazosin (Kardura) with acute urinary retention due to benign prostatic hyperplasia. Urologiia 2001;3:18‐20.

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Referencias adicionales

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otras versiones publicadas

Annemans L, Cleemput I, Lamotte M, McNeill A, Hargreave T. The economic impact of using alfuzosin 10 mg once daily in the management of acute urinary retention in the UK: a 6‐month analysis. BJU International 2005;96:566‐71.

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Referencias de otras versiones publicadas de esta revisión

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Zeif HJ, Subramonian K. Alpha blockers prior to removal of a catheter for acute urinary retention in adult men. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD006744.pub2]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Agrawal 2009

Methods	Prospective, randomised, placebo‐controlled, single centre study
Participants	150 patients ( 50 alfuzosin, 50 tamsulosin, 50 placebo), mean age 69, 72 and 71 years respectively (aged 48 to 90 years)
Interventions	A (50): Alfuzosin 10 mg OD B (50): Tamsulosin 0.4 mg C (50): Placebo, Then TWOC after 3 days
Outcomes	Number who had successful TWOC: A 33/50, B 35/50, C 18/50 Initial catheterisation volume American Urological Association score Post void residual urinary volume (mL) Peak urinary flow rate (mL/sec) Adverse effects
Notes	Second trial phase: successful TWOC patients continued in respective treatment groups and followed up at 1 week, 2 weeks, 1 month and 3 months.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Method of randomisation not specified: '...randomized into three groups.'
Allocation concealment (selection bias)	Unclear risk	Not specified
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	More detail in tables of analysis needed.
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not specified
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	Unclear risk	Other aspects of trial design such as baseline comparability, sample size calculation, use of intention‐to‐treat analysis and financial support were inadequately or not at all specified.

Hua 2003

Methods	Prospective, randomised single centre study
Participants	72 patients (36 tamsulosin, 36 no treatment)
Interventions	A (36): Tamsulosin 0.4 mg once daily for three days B (36): No treatment, TWOC after 3 days (both groups given prophylactic antibiotics)
Outcomes	TWOC success rates:A 22/36 , B 10/36
Notes	Full text article in Chinese with English abstract. TWOC success rates stated in English abstract but no other usable data available for any of the specified outcomes.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	'...were randomly divided into treatment group and control group of 36 patients each.'
Allocation concealment (selection bias)	Unclear risk	Not specified
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete data
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not specified
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	Unclear risk	Other aspects of trial design such as baseline comparability, sample size calculation and financial support not specified.

Kumar 2013

Methods	Prospective, randomised placebo‐controlled single centre study
Participants	60 patients (30 silodosin, 30 placebo). Mean age (SD): Group A: 64.5 (9.3) Group B: 65.8 (8.1)
Interventions	A (30): Silodosin 8 mg once daily for 3 days B (30): placebo
Outcomes	Number who had successful TWOC: A 23/30, B 11/30 Factors influencing TWOC failure Effects of silodosin on uroflowmetry and IPSS in patients who had successful TWOC
Notes	Study conducted in tertiary care regional referral centre in Northern India Successful TWOC: ‘If the patient voided successfully, a postvoid bladder scan was performed to measure his residual urine volume. If there was less than 150 mL postvoid residual volume after voiding at least 100 mL of urine, he was considered to have a successful TWOC.’ Failed TWOC: ‘...if the patient re‐experienced painful AUR or if the PVR urine volume was >150 mL, he was re‐catheterised and considered to have a failed TWOC.’
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	‘...centrally established computer‐assigned randomization list...’
Allocation concealment (selection bias)	Unclear risk	Not specified
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete outcome data
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Placebo administered was ‘similar to silodosin capsule in colour, weight, and shape’ Unclear if personnel were blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	Low risk	Study groups were comparable at baseline Power calculation was performed Ethical approval obtained Written informed consent obtained No withdrawals/loss to follow‐up

Lucas 2005

Methods	Randomised, double‐blind, placebo‐controlled, parallel‐group, multicentre study
Participants	149 patients (75 tamsulosin, 74 placebo), mean age 69.4 years
Interventions	A (75): Tamsulosin 0.4mg once daily B (74): Placebo TWOC 'after up to 8 doses'
Outcomes	Number who had successful TWOC: A 34/75, B 18/74
Notes	Qmax, PVR volume and spontaneously voided volume analysed but not separately (in groups of 'any two successful criteria')
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	'...randomized, double‐blind, placebo‐controlled, parallel‐group, multicentre study'
Allocation concealment (selection bias)	Unclear risk	Not specified ('...randomly assigned to receive...')
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete data
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Double blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	High risk	'This study was sponsored by a grant from Yamanouchi Pharma Ltd.'

McNeill 1999

Methods	Prospective, randomised, placebo‐controlled multicentre trial
Participants	81 patients (40 alfuzosin, 41 placebo), mean age 68.4 years
Interventions	A(40): Alfuzosin SR 5 mg twice daily B (41): Placebo TWOC after 24 hours
Outcomes	Number who had successful TWOC: A 22/40, B 12/41 Factors affecting successful TWOC Incidence of adverse events Incidence of repeat episode of AUR in patients who had successful TWOC Need for surgery in patients who had successful TWOC
Notes	Allocation concealment well explained
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'...tablets was allocated a study number generated randomly by computer'
Allocation concealment (selection bias)	Low risk	'A sealed copy of the code was held by each participating pharmacy, ...'
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete data.
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Double blinded. 'A central pharmacy...packaged the SR alfuzosin and placebo to appear identical...'
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified if assessors were blinded at time of TWOC.
Other bias	High risk	High risk: Baseline comparability: 'The mean age was five years lower in the SR alfuzosin group than in the placebo group (P = 0.049).' Sample size calculation: 'The initial intention was to recruit 100 patients to each arm of the trial, to detect a 20% difference in outcome with 95% power, but such numbers could not be recruited before the trial medication expired'. Financial support was obtained from Lorex Synthélabo UK & Ireland. Low risk: Ethical approval and informed consent obtained. Data were analysed on an intention‐to‐treat basis

McNeill 2005

Methods	Randomised, double‐blind, placebo‐controlled multicentre trial
Participants	363 patients randomised (A 238, B 122. See notes)
Interventions	A (238): Alfuzosin 10 mg once daily B (122): Placebo Then TWOC after 3 days
Outcomes	Number who had successful TWOC: A 146/236, B 58/121 Factors influencing TWOC success
Notes	Second phase of trial: successful TWOC patients again randomised into alfuzosin versus placebo for 6 months (AUR relapse/ BPH surgery need). Data missing for 3 patients therefore results for primary outcome were reported as sub‐totals without these patients (A 236, B 121). Adverse events were however reported as sub‐totals including these patients (A 238, B 122)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'Patients were randomized...according to a centrally established randomization list.'
Allocation concealment (selection bias)	Unclear risk	Not explained
Incomplete outcome data (attrition bias) All outcomes	High risk	Incomplete data for 3 patients
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Double blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	High risk	High risk: Funding obtained from Sanofi‐Aventis Results reported as either intention‐to‐treat or per‐protocol without justification for change. Low risk: Ethical approval and informed consent obtained

Prieto 2008

Methods	Randomised, controlled single centre study
Participants	46 patients (23 doxazosin, 23 no treatment), mean age 74 years
Interventions	A (23): Doxazosin modified release 4 mg once daily B (23): No treatment TWOC on day 32.
Outcomes	TWOC success rates: A 13/22, B 13/24 Maximum urinary flow rate in patients with spontaneous micturition Post‐void residual volume in patients with spontaneous micturition
Notes	Second phase trial: successful TWOC patients review at 6, 12 and 24 months for recurrence of AUR
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	'Two groups were formed.' Patients 'born in even‐numbered years' (doxazosin group) versus 'born in odd‐numbered years' (no treatment group)
Allocation concealment (selection bias)	High risk	Patients 'born in even‐numbered years' (doxazosin group) versus 'born in odd‐numbered years' (no treatment group)
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete data
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding is unlikely given the study design.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	High risk	High risk: Funding obtained from Pfizer. Inconsistency in description of intervention for Group B; no medication versus placebo. Low risk: Ethical approval obtained

Shah 2002

Methods	Randomised, double‐blind, placebo‐controlled single centre study
Participants	62 patients (34 alfuzosin, 28 placebo), mean age 68.6 years
Interventions	A (34): Alfuzosin SR 5 mg twice daily versus B (28): Placebo, TWOC after minimum of three doses or 36 hours after admission
Outcomes	TWOC success rates: A 17/34, B 16/28 Need for further TURP (phase 2)
Notes	Phase 2 of study; all patients with successful TWOC were given Alfuzosin SR 5 mg twice daily and followed up at 1 year and 2 years.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	'...double blind, placebo controlled study...' 'Patients were randomised to receive ...'
Allocation concealment (selection bias)	Unclear risk	Not specified
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete data
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Double blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	High risk	Funding obtained from Lorex Synthelabo Pharma.

Tiong 2009

Methods	Prospectively, randomised trial single centre study
Participants	67 patients (35 alfuzosin, 32 placebo)
Interventions	A (35): Alfuzosin XL 10 mg once daily B (32): Placebo '...TWOC at least 2h after taking the second dose of trial medication.'
Outcomes	TWOC success rates: A (21/35), B (11/32)
Notes	Both patient groups offered alpha blocker treatment after successful TWOC
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomised '...using a centrally established computer‐assigned randomization list'.
Allocation concealment (selection bias)	Low risk	'The allocation and administration of treatment were double‐blinded'.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No incomplete data
Selective reporting (reporting bias)	Unclear risk	All the outcomes as detailed in the method section of the trial were reported in the result section. Some outcomes which are considered important from patients’ perspective were not reported. Without the protocol it was difficult to judge whether or not these outcomes were included in the protocol and not reported in the report.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	'The allocation and administration of treatment were double‐blinded'.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not specified
Other bias	Low risk	Groups comparable at baseline for all characteristics measured (except mean retention urine volume at initial catheterisation; borderline non‐significance [P = 0.06]) Ethical approval and informed consent obtained Low withdrawal rate

AUR = acute urinary retention
BPH = benign prostatic hyperplasia
IPSS = International Prostate Symptom Score
PVR = post‐void residual
TURP = transurethral resection of the prostate
TWOC = trial without catheter
SD = standard deviation
SR = sustained release
XL = extended release

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Joo 2008	Tamsulosin versus no treatment for TWOC in spinal surgery patients electively catheterised perioperatively (not in acute urinary retention prior to surgery).
Kraus 2010	No catheters involved. Urodynamic assessment of daily tadalafil versus placebo on lower urinary tract symptoms.
Lim 1999	No alpha blockers used in study. Study describes outcome of TWOC in 79 untreated patients.
Liu 2009	No catheters involved as patients not in acute urinary retention. Randomised trial of amlodipine with or without terazosin for LUTS.
Lorente 2004	Use of increasing dosage of doxazosin in failed TWOC patients. 40 patients randomly assigned to doxazosin 4 mg once daily (n = 20) or no treatment (n = 20) for seven days before TWOC. Failed TWOC patients either received doxazosin 8mg (treatment group) or 4 mg (control group) once daily before a second TWOC.
Martov 2010	No catheters involved as study assessing tamsulosin for stent‐related irritative symptoms.
McNeill 2004	Long‐term follow‐up study of patient cohort who had successful TWOC following an episode of acute urinary retention (alfuzosin versus placebo).
Taube 1989b	No alpha‐blockers used in study. Study describes outcome of TWOC immediately, after 24 and 48 hours in 60 untreated patients (subdivided into three groups).
Wang 2009	No catheters involved as study assessing effect of tamsulosin in patients with indwelling double‐J ureteral stents.

LUTS = lower urinary tract symptoms
TWOC = trial without catheter

Characteristics of studies awaiting assessment [ordered by study ID]

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estudios excluidos

Perepanova 2001

Methods	Prospective, randomised, controlled trial.
Participants	Patients admitted on an emergency basis with AUR due to benign prostatic hyperplasia.
Interventions	Group A: Doxazosin 4 mg Group B: Placebo Catheters removed after 12 hours.
Outcomes	Number with successful TWOC: A 19/30, B 1/6 Need for further surgery: A10/30, B 5/6
Notes	Paper translated from Russian. Method of randomisation and allocation concealment unclear: 30 patients in Group A, 6 patients in Group B. Which patient received which surgery unclear. No statistical analysis was performed on outcomes.

AUR = acute urinary retention
TWOC = trial without catheter

Data and analyses

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Comparison 1. Alpha blocker versus placebo or control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ability to void spontaneously after TWOC without the need for re‐catheterisation Show forest plot	9	1094	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [1.36, 1.76]
Open in figure viewer Analysis 1.1 Comparison 1 Alpha blocker versus placebo or control, Outcome 1 Ability to void spontaneously after TWOC without the need for re‐catheterisation.
1.1 Alfuzosin versus control	5	667	Risk Ratio (M‐H, Fixed, 95% CI)	1.40 [1.19, 1.64]
1.2 Tamsulosin versus control	3	321	Risk Ratio (M‐H, Fixed, 95% CI)	1.97 [1.49, 2.59]
1.3 Doxazosin versus control	1	46	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.66, 1.81]
1.4 Silodosin versus control	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	2.09 [1.26, 3.48]
2 Incidence of recurrent urinary retention Show forest plot	8	1023	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.60, 0.79]
Open in figure viewer Analysis 1.2 Comparison 1 Alpha blocker versus placebo or control, Outcome 2 Incidence of recurrent urinary retention.
2.1 Alfuzosin versus control	5	667	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.60, 0.85]
2.2 Tamsulosin versus control	2	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.50, 0.87]
2.3 Doxazosin versus control	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.65, 1.48]
2.4 Silodosin versus control	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.18, 0.74]
3 Number with adverse effects due to alpha‐blocker treatment Show forest plot	5	1064	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.75, 1.89]
Open in figure viewer Analysis 1.3 Comparison 1 Alpha blocker versus placebo or control, Outcome 3 Number with adverse effects due to alpha‐blocker treatment.
3.1 Alfuzosin versus control	3	868	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.53, 1.54]
3.2 Tamsulosin versus control	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	2.71 [0.90, 8.14]
3.3 Doxazosin versus control	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	3.13 [0.13, 73.01]
4 Number with serious adverse effects due to alpha‐blocker treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.4 Comparison 1 Alpha blocker versus placebo or control, Outcome 4 Number with serious adverse effects due to alpha‐blocker treatment.
4.1 Alfuzosin versus control	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number of drop‐outs due to adverse effects of alpha blockers treatment Show forest plot	5	705	Risk Ratio (M‐H, Fixed, 95% CI)	3.94 [1.28, 12.12]
Open in figure viewer Analysis 1.5 Comparison 1 Alpha blocker versus placebo or control, Outcome 5 Number of drop‐outs due to adverse effects of alpha blockers treatment.
5.1 Alfuzosin versus control	3	509	Risk Ratio (M‐H, Fixed, 95% CI)	2.83 [0.62, 12.93]
5.2 Tamsulosin versus control	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	6.91 [0.87, 54.76]
5.3 Doxazosin versus control	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	3.13 [0.13, 73.01]

Figure 1

PRISMA study flow diagram

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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Alpha blocker versus placebo or control, Outcome 1 Ability to void spontaneously after TWOC without the need for re‐catheterisation.

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Analysis 1.2

Comparison 1 Alpha blocker versus placebo or control, Outcome 2 Incidence of recurrent urinary retention.

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Analysis 1.3

Comparison 1 Alpha blocker versus placebo or control, Outcome 3 Number with adverse effects due to alpha‐blocker treatment.

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Analysis 1.4

Comparison 1 Alpha blocker versus placebo or control, Outcome 4 Number with serious adverse effects due to alpha‐blocker treatment.

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Analysis 1.5

Comparison 1 Alpha blocker versus placebo or control, Outcome 5 Number of drop‐outs due to adverse effects of alpha blockers treatment.

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Summary of findings for the main comparison. Alpha blocker versus placebo or control for acute urinary retention in adult men

Alpha blocker versus placebo or control for acute urinary retention in adult men
Patient or population: acute urinary retention in adult men Intervention: Aalpha blocker versus placebo or control
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Aalpha blocker versus placebo or control
Ability to void spontaneously after TWOC without the need for re‐catheterisation	Study population		RR 1.55 (1.36 to 1.76)	1044 (9 studies)	⊕⊕⊕⊝ moderate^1,2
	383 per 1000	582 per 1000 (509 to 666)
Incidence of recurrent urinary retention	Study population		RR 0.69 (0.60 to 0.79)	1023 (8 studies)	⊕⊕⊝⊝ moderate^2,3
	507 per 1000	350 per 1000 (304 to 400)
Need for prostatic surgery ‐ not reported	See comment	See comment	Not estimable	‐	See comment
Condition‐specific QoL ‐ not reported	See comment	See comment	Not estimable	‐	See comment
Cost effectiveness ‐ not reported	See comment	See comment	Not estimable	‐	See comment
Number with adverse effects	Study population		RR 1.2 (0.74 to 1.95)	657 (4 studies)	⊕⊕⊝⊝ low^2,4
	74 per 1000	89 per 1000 (55 to 145)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; QoL: quality of life; TWOC: trial without catheter
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Random sequence generation unclear in 4 studies and high risk in 1 study. Allocation concealment unclear in 6 studies and high risk in 1 study. ² A minimum of ten trials are required to assess for publication bias. ³ Random sequence generation unclear in 3 studies and high risk in 1 study. Allocation concealment unclear in 5 studies and high risk in 1 study. ⁴ Wide 95% confidence interval: RR 1.20 (95% CI 0.74 to 1.95)

Summary of findings for the main comparison. Alpha blocker versus placebo or control for acute urinary retention in adult men

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Comparison 1. Alpha blocker versus placebo or control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ability to void spontaneously after TWOC without the need for re‐catheterisation Show forest plot	9	1094	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [1.36, 1.76]

1.1 Alfuzosin versus control	5	667	Risk Ratio (M‐H, Fixed, 95% CI)	1.40 [1.19, 1.64]
1.2 Tamsulosin versus control	3	321	Risk Ratio (M‐H, Fixed, 95% CI)	1.97 [1.49, 2.59]
1.3 Doxazosin versus control	1	46	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.66, 1.81]
1.4 Silodosin versus control	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	2.09 [1.26, 3.48]
2 Incidence of recurrent urinary retention Show forest plot	8	1023	Risk Ratio (M‐H, Fixed, 95% CI)	0.69 [0.60, 0.79]

2.1 Alfuzosin versus control	5	667	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.60, 0.85]
2.2 Tamsulosin versus control	2	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.50, 0.87]
2.3 Doxazosin versus control	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.65, 1.48]
2.4 Silodosin versus control	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.18, 0.74]
3 Number with adverse effects due to alpha‐blocker treatment Show forest plot	5	1064	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.75, 1.89]

3.1 Alfuzosin versus control	3	868	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.53, 1.54]
3.2 Tamsulosin versus control	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	2.71 [0.90, 8.14]
3.3 Doxazosin versus control	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	3.13 [0.13, 73.01]
4 Number with serious adverse effects due to alpha‐blocker treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 Alfuzosin versus control	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number of drop‐outs due to adverse effects of alpha blockers treatment Show forest plot	5	705	Risk Ratio (M‐H, Fixed, 95% CI)	3.94 [1.28, 12.12]

5.1 Alfuzosin versus control	3	509	Risk Ratio (M‐H, Fixed, 95% CI)	2.83 [0.62, 12.93]
5.2 Tamsulosin versus control	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	6.91 [0.87, 54.76]
5.3 Doxazosin versus control	1	47	Risk Ratio (M‐H, Fixed, 95% CI)	3.13 [0.13, 73.01]

Comparison 1. Alpha blocker versus placebo or control

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Referencias

Referencias de los estudios incluidos en esta revisión

Agrawal 2009 {published data only}

Hua 2003 {published data only}

Kumar 2013 {published data only}

Lucas 2005 {published data only}

McNeill 1999 {published data only}

McNeill 2005 {published data only}

Prieto 2008 {published data only}

Shah 2002 {published data only}

Tiong 2009 {published data only}

Referencias de los estudios excluidos de esta revisión

Joo 2008 {published data only}

Kraus 2010 {published data only}

Lim 1999 {published data only}

Liu 2009 {published data only}

Lorente 2004 {published data only}

Martov 2010 {published data only}

McNeill 2004 {published data only}

Taube 1989b {published data only}

Wang 2009 {published data only}

Referencias de los estudios en espera de evaluación

Perepanova 2001 {published data only}

Referencias adicionales

Annemans 2005

Barry 1997

Batista‐Miranda 1995

Bird 2013

BNF December 2013

Caine 1975

Caine 1976

Caine 1987

Emberton 1999

Fulton 1995

Guyatt 2011

Guyatt 2011a

Guyatt 2013a

Guyatt 2013b

Haylen 2010

Higgins 2011

Jacobsen 1997

Lamotte 2005

McConnell 1998

Meigs 1999

Murray 1984

Niël‐Weise 2005

Omar 2014

Pickard 1998

Ramirez 2013

Ramirez 2014

Reference Manager 2012

Roerborn 2000

Schulman 2001

Taube 1989a

Temml 2003

Thomas 2005

Verhamme 2005

Referencias de otras versiones publicadas de esta revisión

Zeif 2009

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of studies awaiting assessment [ordered by study ID]

Data and analyses

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Usuarios institucionales

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