A meta-analysis of the efficacy of prophylactic alpha-blockade for the prevention of urinary retention following primary unilateral inguinal hernia repair

• Published in: The American journal of surgery 2018-08, Vol.216 (2), p.337-341
• Main Authors: Clancy, C, Coffey, J.C, O'Riordain, M.G, Burke, J.P
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Age; Alpha blockers; Anesthesia; Bladder; Complications; Hernia; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - adverse effects; Inguinal hernia; Males; Meta-analysis; Methods; Muscles; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prevention; Prostate; Retention; Smooth muscle; Studies; Surgery; Treatment Outcome; Urinary retention; Urinary Retention - etiology; Urinary Retention - prevention & control; Urogenital system
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.02.017

Abstract Background Urinary retention following inguinal hernia surgery is common and is believed to be associated with adrenergic over-stimulation of the smooth muscle in the bladder neck and prostate. The efficacy of prophylactic alpha-blockade in the prevention of urinary retention following elective inguinal hernia repair in males is unknown. Methods A comprehensive literature search was performed adhering to PRISMA guidelines. Each study was reviewed and data were extracted. Random-effects models were used to combine data. Results Five randomized studies describing 456 patients were identified. General or spinal anaesthetic were used. Prophylactic alpha-blockade decreases the risk of urinary retention requiring catheterisation following elective unilateral inguinal hernia repair compared to control groups (OR:0.179, 95% CI:0.043–0.747, p:0.018). Rates of urinary retention between treatment and control groups are reduced by 20.6%. No serious complications relating to alpha blockade occurred. Conclusions Prophylactic alpha-blockade reduces urinary retention following elective inguinal hernia surgery under general or spinal anaesthetic. Summary Urinary retention is common following inguinal hernia surgery. It is believed to be associated with adrenergic over-stimulation of the smooth muscle in the bladder neck and prostate. Prophylactic alpha-blockade reduces the rates of urinary retention by 20.6% in adult males undergoing general or spinal anaesthetic with minimal associated side effects.