A patient with acute urinary retention in the emergency department. Defining management strategy

Kopanova V.V., Neimark A.I., Nozdrachev N.A., Davydov A.V., Neimark B.A.

1) Department of Urology and Andrology with a CME course, Altai State Medical University, Ministry of Health of Russia, Barnaul, Russia; 2) Urology Department, Clinical Hospital “RZD-Medicine”, Barnaul, Russia; 3) Urology Department, City Clinical Emergency Hospital No. 2, Barnaul, Russia

Aim. To evaluate the efficiency and safety of the rectal formulation of an α1A-adrenoblocker in combination with prostatic peptides (Prostatex Plus) in restoring urination in patients with first-onset acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH).
Materials and methods. A multicenter study of Prostatex Plus was carried out as a product with both symptomatic and pathogenetic mechanisms of action. Considering the importance of improving adherence in older comorbid patients, ease of use, and minimizing adverse effects, the choice of combining two active substances in a single suppository is evident. The study included 74 patients with first-onset AUR associated with BPH. All patients presented to the emergency department of an emergency hospital. After receiving urgent care, which included single bladder drainage via urethral catheterization, patients were discharged for outpatient follow-up. The main group included 44 patients who received Prostatex Plus, one suppository in the emergency department and then for 20 days at night into an emptied rectum. The comparison group included 30 patients who received an α1A-adrenoblocker orally (tamsulosin) in the emergency department and then daily for 20 days in the morning. Patients were assessed at baseline, and at 7 and 20 days after the initial visit.
Results. Patients aged 69 to 80 years were included (mean age 75.5±3.58 years). The mean duration of BPH was 2±4.5 years (from 1.2 to 9 years). The urine volume at AUR ranged from 300 to 980 mL, with a mean of 650±120 mL. The duration of urinary retention was 8±4.2 h (from 3 to 11 h). With Prostatex Plus, spontaneous voiding was restored in 35 (79.5%) patients, whereas with oral tamsulosin it was restored in 18 (64.2%). At subsequent visits, voiding quality assessed by uroflowmetry and the IPSS was significantly better in the Prostatex Plus group than in the comparison group.

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About the Authors

Corresponding author: Nozdrachev Nikolay Aleksandrovich – Ph.D., Associate Professor, Department of Urology and Andrology with a CME course, Altai State Medical University, Ministry of Health of Russia, Barnaul, Russia; e-mail: nozdrachevuro@mail.ru

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