Tamsulosin to Prevent Urinary Retention After Vaginal Urogynecologic Surgery

Importance Postoperative urinary retention (POUR) affects up to 51% of women undergoing surgery for pelvic organ prolapse (POP). Effective prevention strategies remain elusive, although alpha receptor antagonists show promise in recent literature. Objectives This study sought to evaluate the effect of preoperative tamsulosin on POUR after vaginal surgery for POP. Study Design We conducted a retrospective cohort study of female patients undergoing vaginal surgery for POP, with or without concomitant midurethral sling. Patients who received preoperative tamsulosin were compared with controls. All patients were discharged on the day of surgery after undergoing a standardized voiding trial. The primary outcome was the rate of POUR, defined by a failed voiding trial. Secondary outcomes included complication rates and risk factors for POUR. Results A total of 195 patients were included for analysis, with 60 patients (30.8%) receiving tamsulosin and 135 (69.2%) not. Baseline demographics were similar between groups, except the tamsulosin group had lower parity and were less likely to splint to void. The tamsulosin group had similar rates of POUR compared with control (31.7% vs 34.8%, P = 0.67). Multivariate logistic regression controlling for confounders showed no significant effect of tamsulosin on POUR rates (odds ratio, 0.65; 95% confidence interval, 0.31-1.35; P = 0.24). Concomitant sling placement was identified as the only independent risk factor for POUR (odds ratio, 3.00; 95% confidence interval, 1.55-5.81; P = 0.001). Conclusions Preoperative tamsulosin does not appear to be effective in preventing postoperative urinary retention in women undergoing vaginal surgery for POP, whereas concomitant sling placement appears to increase its risk.