Do alpha blockers reduce the risk of urinary retention post-transperineal prostate biopsy? A systematic narrative review

Zein Alhamdani; Samuel Poppenbeek; Damien Bolton; Lih-Ming Wong; Kapil Sethi

doi:10.1007/s00345-024-05001-5

Do alpha blockers reduce the risk of urinary retention post-transperineal prostate biopsy? A systematic narrative review

World J Urol. 2024 May 17;42(1):332. doi: 10.1007/s00345-024-05001-5.

Authors

Zein Alhamdani¹, Samuel Poppenbeek², Damien Bolton³, Lih-Ming Wong^{3

2}, Kapil Sethi^{3

2}

Affiliations

¹ Department of Urology, University of Melbourne, Austin Health, 145 Studley Rd, Heidelberg VIC, Melbourne, 3084, Australia. zeinfiras@hotmail.com.
² Department of Surgery, University of Melbourne, St Vincent's Health, Melbourne, Australia.
³ Department of Urology, University of Melbourne, Austin Health, 145 Studley Rd, Heidelberg VIC, Melbourne, 3084, Australia.

Abstract

Background: Transperineal Prostate Biopsy (TPB) is a commonly used technique for the diagnosis of prostate cancer due to growing concerns related to infectious complications associated with transrectal ultrasound-guided prostate biopsy (TRUSB). TPB is associated with an infective complication rate of near zero, however, acute urinary retention (AUR) remains the leading complication causing morbidity. Previously in TRUSB, there was weak evidence that alpha-blockers reduce AUR rates, and their usage has been extrapolated to clinical practice with TPB. This review aims to explore if there is an evidence base for using alpha-blockers to prevent AUR following TPB.

Methods: A systematic approach was used to search Ovid Medline and Embase using keywords related to "Transperineal" and "Retention". Articles were then screened by applying inclusion and exclusion criteria to find studies that compared alpha-blocker recipients to no alpha-blocker use in the perioperative period and the subsequent effect on AUR in TPB.

Results: 361 records were identified in the initial search to produce 5 studies included in the final review. No randomised controlled trials (RCTs) were identified. One observational study showed a reduction in AUR rate from 12.5% to 5.3% with a single dose of tamsulosin. A previous systematic review of complications associated with prostate biopsy concluded there may be a potential benefit to alpha-blockers given in the TPB perioperative period. Three observational studies demonstrated a harmful effect related to alpha-blocker use; however, this was well explained by their clear limitations.

Conclusion: Based on this review and the extrapolation from TRUSB data, perioperative alpha-blockers may offer some weak benefits in preventing AUR following TPB. However, there is significant scope and need for an RCT to further develop the evidence base further given the significant gap in the literature and lack of a standard alpha blocker protocol in TPB.

Keywords: Alpha blockers; Systematic review; Transperineal Prostate biopsy; Urinary retention; Uro-oncology.

Publication types

Systematic Review

MeSH terms

Adrenergic alpha-Antagonists / therapeutic use
Humans
Image-Guided Biopsy / adverse effects
Image-Guided Biopsy / methods
Male
Perineum*
Postoperative Complications / etiology
Postoperative Complications / prevention & control
Prostate* / pathology
Prostatic Neoplasms / pathology
Urinary Retention* / etiology
Urinary Retention* / prevention & control