The Effect of Oral Tamsulosin vs. Oral Tamsulosin and Oral Isosorbide Dinitrate in Acute Urinary Retention Patients Due to Benign Prostatic Hyperplasia: A Double-Blind Clinical Trial Study


Introduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. Objective: The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. Methods: This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. Results: After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). Conclusions: Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant.

1. Roger S. Kirby JDM, John M. Fitzpatrick, Claus G. Roehrborn, Peter Boyle. Textbook of Benign Prostatic Hyperplasia. 2nd Edition. Oxon, UK: CRC Press; . 2004.
2. Hartung R. Do alpha-blockers prevent the occurrence of acute urinary retention? Eur Urol. 2001;39:13-8.
3. Oelke M, Speakman MJ, Desgrandchamps F, Mamoulakis C. Acute Urinary Retention Rates in the General Male Population and in Adult Men With Lower Urinary Tract Symptoms Participating in Pharmacotherapy Trials: A Literature Review. Urology. 2015;86(4):654-65.
4. Thomas K, Chow K, Kirby RS. Acute urinary retention: a review of the aetiology and management. Prostate Cancer Prostatic Dis. 2004;7(1):32-7.
5. Lepor H. Managing and preventing acute urinary retention. Rev Urol. 2005;7(Suppl 8):S26-33.
6. Emberton M, Fitzpatrick JM. The Reten-World survey of the management of acute urinary retention: preliminary results. BJU Int. 2008 Mar;101 Suppl 3:27-32.
7. Kara O, Yazici M. Is the double dose alpha-blocker treatment superior than the single dose in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia? Urol J. 2014;11(3):1673-7.
8. Kumar S, Tiwari DP, Ganesamoni R, Singh SK. Prospective randomized placebo-controlled study to assess the safety and efficacy of silodosin in the management of acute urinary retention. Urology. 2013;82(1):171-5.
9. Maldonado-Avila M, Manzanilla-Garcia HA, Sierra-Ramirez JA, Carrillo-Ruiz JD, Gonzalez-Valle JC, Rosas-Nava E, et al. A comparative study on the use of tamsulosin versus alfuzosin in spontaneous micturition recovery after transurethral catheter removal in patients with benign prostatic growth. Int Urol Nephrol. 2014;46(4):687-90.
10. Roehrborn CG, Bruskewitz R, Nickel GC, Glickman S, Cox C, Anderson R, et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. The PLESS Study Group. Eur Urol. 2000;37(5):528-36.
11. Hua LX, Wu HF, Sui YG, Chen SG, Xu ZQ, Zhang W, et al. [Tamsulosin in the treatment of benign prostatic hyperplasia patients with acute urinary retention]. Zhonghua Nan Ke Xue. 2003;9(7):510-1.
12. Muntener M, Schurch B, Wefer B, Reitz A. Systemic nitric oxide augmentation leads to a rapid decrease of the bladder outlet resistance in healthy men. Eur Urol. 2006;50(1):112-7.
13. Roshani A, Khosropanah I, Salehi M, Kamran AN. Effects of isosorbide dinitrate on the urinary flow rate in patients with benign prostatic hyperplasia. Urol J. 2010;7(3):183-7.
14. Tadayyon F, Izadpanahi M, Aali S, Mazdak H, Khorrami M-H. The effect of sublingual isosorbide dinitrate on acute urinary retention due to benign prostatic hyperplasia. Saudi J Kidney Dis Transpl. 2012;23(4):782-5.
15. Tarhan F, Celik O, Tosun C, Faydaci G, Eryildirim B. Comparison of the efficacy of isosorbide mononitrate and doxazosin in the treatment of lower urinary tract symptoms and benign prostatic hyperplasia: a randomized clinical trial. Urol Int. 2014;93(1):17-21.
16. Lucas MG, Stephenson TP, Nargund V. Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int. 2005;95(3):354-7.
17. Karavitakis M, Kyriazis I, Omar MI, Gravas S, Cornu JN, Drake MJ, et al. Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. Eur Urol. 2019;75(5):788-98.
18. Kuiper JG, Bezemer ID, Driessen MT, Vasylyev A, Roehrborn CG, Penning-van Beest FJA, et al. Rates of prostate surgery and acute urinary retention for benign prostatic hyperplasia in men treated with dutasteride or finasteride. BMC Urol. 2016;16(1):53.
19. Michel MC, Goepel M. Lower urinary tract symptoms suggestive of benign prostatic obstruction--what's the long-term effectiveness of medical therapies? Eur Urol. 2001;39 Suppl 3:20-5.
20. Bansal A, Arora A. Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: A single centre, multivariate analysis. Neurourol Urodyn. 2017;36(7):1757-62.
21. Mahadik P, Vaddi SP, Godala CM, Reddy VV, Sambar VK. Factors affecting trial without catheter for first spontaneous acute urinary retention. Int Neurourol J. 2013;17(3):121-6.
22. Daly P, Connolly S, Rogers E, Sweeney P. Management outcome of acute urinary retention: model of prediction. Urol Int. 2009;83(1):39-43.
IssueVol 5 No 2 (2021): Spring (April) QRcode
SectionOriginal article
DOI 10.18502/fem.v5i2.5610
Acute Urinary Retention Benign Prostatic Hyperplasia Isosorbide Dinitrate Tamsulosin

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Golikhatir I, Feyzzadeh Kerigh B, Sazgar M, Jahanian F, Assadi T, Zakariae Z, Amri Sarokolaei R, Aminiahidashti H. The Effect of Oral Tamsulosin vs. Oral Tamsulosin and Oral Isosorbide Dinitrate in Acute Urinary Retention Patients Due to Benign Prostatic Hyperplasia: A Double-Blind Clinical Trial Study. Front Emerg Med. 5(2):e18.


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