Anthony Tabatabai, DO, John Vance, DO, Christopher Ash, DO, Mark Vance, DO, Andrea Goethals, DO, Kimberly Barber, PhD. Genesys Regional Medical Center
Introduction: The current standard of care does not include prophylactic doses of an alpha-adrenergic blocker in preventing post-operative urinary retention among patients undergoing hernia repair. This study aimed to test the efficacy of tamsulosin for preventing post-operative urinary retention among males undergoing elective inguinal hernia repair. Avoiding post-operative urinary retention may decrease medical costs, hospital admissions, extended recovery observation, and return to emergency room for inability to urinate.
Methods and Procedures: This was a double blind, randomized controlled prospective trial evaluating two preoperative doses of tamsulosin an alpha-adrenergic blocker in preventing post-operative urinary retention (POUR). Patients were enrolled from January 2017 to September 2018 in a community hospital. Tamsulosin versus placebo medication in males over the age of 30 who have no history of benign prostatic hypertrophy nor who are taking any alpha-adrenergic blocker or 5 alpha reductase blocker for issues of urinary retention were selected. Patients were undergoing elective laparoscopic, open, or robotic assisted unilateral or bilateral inguinal hernia repair. They received two doses of 0.4 mg (tamsulosin vs placebo) preoperatively, the night before surgery and the morning of surgery. POUR was defined as the inability to spontaneously urinate following surgery requiring straight catheterization or placement of a Foley catheter for urinary retention within 72 hours of surgery. Post-operative catheterization rates were compared for significance at p< 0.05 with Chi square analysis.
Results: A total of 210 patients were enrolled into the study. Of them 193 (92%) completed taking the drug as directed and having an inguinal hernia repair. Patients were randomly assigned to either the tamsulosin group (110 or 57%) or the placebo group (83 or 43%). A total of 16 (8.3%) patients had urinary retention. The tamsulosin group had 4 (4.8%) retentions and the placebo group had 12 (11%). This was a 42% relative decrease for the treatment group (p=0.10). Procedures were further subdivided by technique, 105 (54%) Robotic assisted, 64 (33%) open, and 24 (12%) laparoscopic. Among 105 robotic procedures, there was a relative difference of 52% in retention rates between groups [3 (6.7%) tamsulosin, 8 (13.3%) placebo, p=0.13].
Conclusion: Though it did not reach statistical significance, a clinically meaningful difference was observed in the rates of retention between the two groups. This large difference was supported among those with robotic assisted procedures and suggests that prophylaxis with a selective alpha 1-A adrenergic receptor antagonist may prevent urinary retention following hernia surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94283
Program Number: P603
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster