Postoperative urinary retention has been defined as the inability to void despite having
fluid in the bladder during the postoperative period. Urinary retention after pelvic
reconstructive surgery requiring indwelling catheter or self-catheterization usage occurs
in approximately 30-60% of patients postoperatively.
During a retro-fill voiding trial, the bladder is back-filled with a set amount of
sterile water (often 300mL), the catheter is removed, the patient is permitted to void
and the voided volume is compared with a bladder scan post void residual volume.
"Passing" a voiding trial has previously been defined as voiding equal or greater than ⅔
the residual volume, whereas others characterize "passing" as voiding at least 200mL and
voiding a greater volume than the post-void residual volume. If the patient does not
"pass" the voiding trial, the patient is characterized as having postoperative urinary
retention and is discharged home with an indwelling catheter to prevent detrusor injury
from bladder over-distention, pain and urinary tract infection.
Many women consider being discharged home with a foley catheter to be a surgical
complication and describe catheter use as the worst aspect of their surgery. Indwelling
catheters are the leading cause of hospital-acquired urinary tract infections (UTIs), are
often a source of embarrassment and inconvenience for patients, and often require
additional office visits and healthcare utilization.
Tamsulosin is an alpha-adrenergic receptor blocker which is thought to increase smooth
muscle relaxation and improve urinary flow. Current literature has been primarily focused
on the effect of tamsulosin in men with benign prostatic hyperplasia, however may be
beneficial in women as well with limited studies for postoperative urinary retention.
Chapman, et al published a randomized control trial evaluating postoperative urinary
retention after female pelvic reconstructive surgery. These patients underwent 10 days of
tamsulosin (3 days preoperative and 7 days postoperative) and were found to have a 65%
decrease in the urinary retention rate from 25.8% to 8.8%. Livne, et al published a study
evaluating postoperative urinary retention decrease of 79.2% after postoperative
administration of dibenzyline (an alpha-adrenergic receptor blocker) in women undergoing
hysterectomy (post-operative urinary retention rate of 18.75% in controls and 3.9% in the
treatment group). Additional studies have also been published evaluating postoperative
urinary retention in men and women undergoing various surgeries and have demonstrated a
decrease in postoperative urinary retention after tamsulosin administration from 72-88%
compared with controls. These studies vary in tamsulosin administration from multiple
days preoperative and postoperative to multiple doses preoperative and postoperative to a
single postoperative dose, however no studies have been published in evaluating a single
preoperative dose of tamsulosin and the effect on postoperative urinary retention. This
has previously been studied as tamsulosin reaches a steady state in approximately 5 days,
however when tamsulosin is given in a fasting patient, it can reach the maximum blood
concentration in approximately 4-5 hours. As the majority of female pelvic reconstructive
surgeries performed by our department are same-day surgeries, with patients being
discharged the day of surgery, the investigators would like to investigate the effect of
a single preoperative dose of tamsulosin on postoperative urinary retention and, by
effect, home catheter usage after surgery. Tamsulosin is cost-effective at approximately
$2 per tablet. Despite primarily being prescribed for benign prostatic hyperplasia,
tamsulosin has been found to be a safe and well-tolerated treatment for voiding
dysfunction in women.
Postoperative urinary retention is common after pelvic reconstructive surgery with
mid-urethral sling placement and is extremely bothersome to patients. Tamsulosin is a
low-risk, well tolerated, cost-effective medication that studies have suggested may
decrease the rate of postoperative urinary retention. No study to date has evaluated
preoperative administration of single- dose tamsulosin for postoperative urinary
retention in a randomized placebo-controlled trial.
