1. 5/7/13
Does Flomax Reduce Rates of
Post-op Urinary Retention in NSX
Patients?
Azam Basheer MD
Mohammed Alsaidi MD
Muwaffak Abdulhak MD
Mokbel Chedid MD
Donald Seyfried MD
Department of Neurosurgery
Henry Ford Hosital
Detroit, MI

2. Post Operative Urinary Retention
• Definition:
inability to empty bladder completely
• Sequelae:
− Pain/anxiety
− Bladder distention and damage
− Longer hospital stay
− Renal failure
• Standard treatment:
− Straight catheterization  strictures, trauma, infection & delirium
− Foley re-insertion

3. Incidence
• 5 to 75% of all surgical
procedures
• Highest in urologic,
colorectal and certain
orthopedics procedures
(hip sx)

4. POUR in Neurosurgery
• Has not been extensively studied
• Boulis et al. 39.1% in 503 spine patients
• McLain et al. 23% in 200 L-spine patients
• Jellish et al. 22.9% in 61 L-spine patients

6. Study Design
• 137 patients prospectively followed for the
development of POUR
• Definition: Post void residual (PVR) >250 ml 6
hours after the removal of the indwelling urinary
catheter (IUC)
• For patients with PVR >250 ml on the third
check, IUCs were re-inserted, and kept for 5-7
days.

8. Results
• The overall incidence of clinical POUR
was 39.4%
• Statistical significance (p< 0.05) for high
PVR1 was noted in
− Males
− Patients older than 60 years of age
− Spine surgery

9. PVR1 information by patient
characteristics:
0
100
200
300
400
500
Male Female
Gender (p<0.001)
MeanPVR1(SE)
0
100
200
300
400
500
<60 years 60+ years
Age (p=0.043)
MeanPVR1(SE)
0
100
200
300
400
500
<=200 min >200 min
Surgery Time (p=0.08)
MeanPVR1(SE)
0
100
200
300
400
500
Cranial C/T Lumbar
Surgery location (p=0.012)
MeanPVR1(SE)

10. 5/7/13
PVR1 information by patient
characteristics:
0
100
200
300
400
500
Yes No
Diabetes (p=0.10)
MeanPVR1(SE)
0
100
200
300
400
500
Yes No
Beta Blockers (p=0.079)
MeanPVR1(SE)
0
100
200
300
400
500
Yes No
anticholinergic (p=0.634)
MeanPVR1(SE)
0
100
200
300
400
500
<=30 >30
BM I (p=0.265)
MeanPVR1(SE)

11. Results cont.
• 24 (18%) pts had
IUCs re-inserted
• The association of
IUC re-insertion
with male gender
was significant

12. 5/7/13
POUR and Length of Hospital Stay (p=0.04)

13. Conclusion
• POUR is prevalent among NSX patients,
especially in males, older than 60 years of age,
and those with spinal pathologies.
• It leads to higher rates of infection and longer
hospital stay.

14. Preventive effect of tamsulosin on
postoperative urinary retention in
neurosurgical patients

15. Flomax
• Well-tolerated
• Effective in people
with BPH
• Commonly prescribed
by the consulting
urology department
when NSX patients
develop POUR

16. Potential Benefits
• Reduction in morbidity related to
treatment of urinary retention
• Shortened hospital stays
• Decreased healthcare costs

17. 5/7/13
Urology Literature
Effectiveness of tamsulosin in prevention of post-operative urinary
retention: a randomized double-blind placebo-controlled study.
2/2014
Scrotal surgery. 232 patients Flomax reduced POUR (5.9% vs. 21.1%)
Prophylactic tamsulosin (Flomax) in patients undergoing prostate
brachytherapy for prostate carcinoma: final report of a double-blind
placebo-controlled randomized study. 5/2005
Prostate surgery. 126 patients. No difference, but positive impact on urinary symptoms at Week 5
Preventive effect of tamsulosin on postoperative urinary retention
6/2012
inguinal herniorrhaphy. Double-blinded. 80 patients. Flomax reduced POUR (2.5% vs 15%)

18. Methods
• A double blinded, two-armed randomized controlled trial
• 95 male neurosurgical patients undergoing spine surgery
were enrolled and followed up for the development of
POUR
• Participants were randomized to receive 0.4 mg/day
Flomax vs Placebo from 2 days prior to the operation
until foley removal post-op

19. Inclusion criteria
• All male patients that undergoing
spine surgery, age 18 to 80

20. Exclusion criteria
1. Being on Flomax within the last one month.
2. Patients with history of moderate to severe orthostatic hypotension
3. Patients who make less than 200 ml/day of urine preoperatively (i.e. end
stage renal disease, renal failure)
4. Patients with allergies to Tamsulosin or sulfonamides hypersensitivity
5. Patients who have chronic urinary catheterization
6. Patients with alterative voiding pathways, such as suprapubic catheters
7. Patients who will be admitted to the intensive care unit.
8. Patients with history of symptomatic hypotension. Patients will be excluded
in clinic if they have a systolic blood pressure < 90.
9. History of severe heart failure or major cardiovascular event within the
previous 6 months.
10. Patients with current ALT or AST > 1000, or Crt > 2.5 during their clinic
visits.
11. Patients who are actively taken medication that may interact with
Flomax( See Clinic Exclusion Medication list)

21. 5/7/13
Patient Characteristics

22. 5/7/13
Surgery Variables

23. 5/7/13
POUR
Overall, the rate of developing POUR was
similar in the control and treatment groups
16 pts (36%) who were given Tamsulosin
developed POUR compared to 13 pts
(28%) from the placebo group (P = 0.455)

24. 5/7/13
PVR
0
50
100
150
200
250
300
350
Flomax Placebo
PVR 1
PVR 2
PVR 3

25. 5/7/13
Foley Re-insertion
Of the control group, 5 pts (11%) had foley
catheters re-inserted postoperatively
While 7 (14%) pts in the tamsulosin group
had the foley re-inserted (p = 0.616)

26. 5/7/13
Conclusion
Tamsulosin peri-
operatively showed
no real benefit in
decreasing the
incidence of POUR

27. Reasons for this?

Placebo effect

Multi-factorial cause for POUR

Sample size

Long term follow up

Pain medication use

28. References
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29. 5/7/13
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