Authors' objectives: Identify and summarize evidence on the safety and effectiveness of alpha-adrenergic blocking agents for prevention of urinary retention and catheter-associated urinary tract infection (CAUTI) in hospitalized medical patients with indwelling urinary catheters (IUC).

Authors' results and conclusions: EVIDENCE SUMMARY ▪ Acute urinary retention (AUR) is most frequently caused by benign prostate hyperplasia (BPH) in men. Immediate decompression of the bladder with an indwelling urinary catheter (IUC or Foley catheter) is the first step of treatment. ▪ Administration of an alpha-blocking drug (alfuzosin, tamsulosin, or silodosin) prior to removal of the IUC increases the likelihood of the patient being able to urinate after the IUC is removed (successful trial without catheter–TWOC) and reduces the risk of recurrent AUR. The evidence for these conclusions was of moderate strength due to risk of bias. ▪ Differences in effectiveness and safety between tamsulosin, alfuzosin, and silodosin are not statistically significant, though additional evidence may change this conclusion (evidence level: low). The combination of alfuzosin and tamsulosin may be more effective than either of the drugs alone (evidence level: low). ▪ Continuing administration of the alpha blocker for 7 days instead of 3 days increases the likelihood of successful TWOC but also increases the risk of adverse events (evidence level for both conclusions: low). ▪ Addition of sildenafil or ketoconazole to tamsulosin may increase the likelihood of successful TWOC (evidence level: very low). There is not sufficient evidence on which to base conclusions about the risk of adverse events. ▪ Almost all of the evidence is from studies of men with BPH. Evidence from women (AUR is much less common in women), from subgroups of men such as those without BPH, or from patients already hospitalized with other conditions is lacking.

Project Status: Completed

Year Published: 2025

URL for published report: https://www.med.upenn.edu/CEP/external-request-form.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Penn Medicine Center for Evidence-based Practice

Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104

Contact Name: Nikhil Mull

Contact Email: cep@pennmedicine.upenn.edu

Copyright: <p>Center for Evidence-based Practice (CEP)</p>