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PRISMA study flow diagram
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Figure 1

PRISMA study flow diagram

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'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 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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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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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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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 1.1

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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Comparison 1 Alpha blocker versus placebo or control, Outcome 2 Incidence of recurrent urinary retention.
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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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Comparison 1 Alpha blocker versus placebo or control, Outcome 3 Number with adverse effects due to alpha‐blocker treatment.
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Analysis 1.3

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

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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 1.4

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

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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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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)

⊕⊕⊕⊝
moderate1,2

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)

⊕⊕⊝⊝
moderate2,3

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)

⊕⊕⊝⊝
low2,4

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)

Figuras y tablas -
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]
Figuras y tablas -
Comparison 1. Alpha blocker versus placebo or control
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