Urinary Retention

What must be done for acute urinary retention?

= painful inability to pass urine.

Requires hospital admission for catheterisatiaon and an alpha-adrenoceptor blocker before the removal of the catheter for at least 2 days.

Alpha blockers: alfuzosin hydrochloride, doxazosin, tamsulosin hydrochloride, prazosin, indoramin, terazosin

What is done for chronic urinary retention?

= non-painful long term inability to pass urine.

Treated with intermittent bladder catheterisation or surgical urostomy.

How is benign prostatic hyperplasia treated?

How does treatment differ if enlarged prostate or raised prostate antigens?

Alpha blocker to relax smooth muscles.

If caused by an enlarged prostate or raised prostate antigens (50% of patients), can use a 5-alpha-reductase inhibitor.

When are alpha blockers contraindicated?

• Postural hypotension

• Micturition syncope - temporary loss of consciousness after urination

When should the first dose of alpha blockers be given?

Give first dose at bed time as it can cause first dose hypotension.

What is the major side effect of alpha blockers?

Hypotension

What type of drugs do alpha blockers interact with?

Other drugs that cause hypotension

List the 5-alpha-reductase inhibitors

Dutasteride, finasteride

What is the MHRA warning associated with finasteride?

Reports of psychiatric side effects (depression and suicidal thoughts, STOP IMMEDIATELY) and of sexual side effects (decreased libido and erectile dysfunction which may persist after treatment discontinuation)

What type of cancer has been reported with 5-alpha-reductase inhibitors?

Male breast cancer - report lumps, pain, or nipple discharge

What is the advice in pregnancy and women of children age regarding handling of tablets?

Can be absorbed through the skin.

Women of childbearing potential should avoid handling crushed or broken tablets of finasteride.

What is the advice in conception / contraception with 5-alpha-reductase inhibitors?

Finasteride is excreted in semen - use of a condom is recommended if sexual partner is pregnant or likely to become pregnant.