Efficacy And Safety Of Tamsulosin In Preventing Postoperative Urinary Retention:A Systematic Review

Objective: To evaluate the efficacy and safety of tamsulosin in preventing postoperative urinary retention with the methods of systematic review and GRADE,and providing evidence for clinical practice.Methods: We searched the Cocharane Central Register of Controlled Trials(CENTRAL,Issue 8,2016),MEDLINE(1950 to August 2016),EMBASE(1980 to August 2016),China Biomedicine Database(CBM,1970 to August 2016),China National Knowledge Infrastructrue(CNKI,1970 to August 2016),Chinese Science and Technology Periodical Database(VIP,1970 to August 2016),Wanfang Database(1970 to August 2016)and Clinical trial registry platform to identify randomized controlled trials(RCTs)involving tamsulosin in the prevention of postoperative urinary retention.No restrictions on language and publication status.Two reviewers selected studies and assessed the methodological quality,extracted data independently,and unified data after cross-checking.Discussion or the third reviewer when needed resolved the disagreement.We assessed the efficacy and safety of tamsulosin in preventing postoperative urinary retention by the incidence of postoperative urinary retention,average postoperative hospitalization time,Incidence of urinary tract infection and incidence of adverse reactions,etc.Meta-analysis was performed using Rev Man 5.3.Dichotomous outcomes was indicated by risk ratios(RR)with 95%CI,and mean difference(MD)with 95%CI were used to report continuous outcomes.The quality of evidence was graded by GRADEpro GDT,strength of recommendation also were made.Results:A total of 10 RCTs involving 1105 patients were included.The methodological quality of all included studies were not high.The results of this systematic review showed that:(1)Incidence of postoperative urinary retention: All 10 RCTs including 1105 patients reported incidence of postoperative urinary retention,meta-analysis showed that tamsulosin could significantly reduce the incidence of postoperative urinary retention,and there was significant difference between tamsulosin group and control group [RR=0.29,95%CI(0.20,0.42),P < 0.00001].(2)Average postoperative hospitalization time: 2 RCTs involving 148 patients reported average postoperative hospitalization time,meta-analysis showed that there was a significant difference between the two groups in average postoperative hospitalization time[MD=-0.53,95%CI(-1.00,-0.06),P=0.03].(3)Incidence of urinary tract infection: only 1 RCTs reported incidence of urinary tract infection.There was no difference observed in the two groups [RR=0.11,95%CI(0.01,1.84),P=0.12].(4)Incidence of urinary disorder: 1 RCT reported incidence of urinary disorder,the results of the study showed that tamsulosin could reduce the incidence of urinary disorder,and there was a significant difference between the two groups in this outcome[RR=0.20,95%CI(0.05,0.88),P=0.03].(5)The ratio of postoperative using pethidine: 1 RCT reported the ratio of postoperative using pethidine.There was no difference observed in the two groups[RR=0.67,95%CI(0.32,1.41),P=0.29].(6)Time of postoperative indwelling catheter: 1 RCT reported the time of postoperative indwelling catheter.There was no difference observed in the two groups[MD=2.46,95%CI(-0.19,5.11),P=0.07].(7)Incidence of adverse reactions: 7 RCTs including 523 patients reported tamsulosin related adverse reactions,the total adverse reactions was 1.15%.All studies showed that there was no significant difference between the two groups in the incidence of adverse reactions.The quality of evidence was morderate.Conclusion:This study evaluated the efficacy and safety of tamsulosin in preventing postoperative urinary retention systematically.There is moderate evidence to support the use of tamsulosin in preventing postoperative urinary retention,and the strength of recommendation is weak.Due to the limited quantity and quality of the included studies,more high quality RCTs with large sample size are needed to verify the above conclusion.