Objective:
To investigate whether combination therapy is more effective than either monotherapy in reducing the relative risk for benign prostate hyperplasia (BPH)-related surgery in patients with acute urinary retention (AUR).
Methods:
We retrospectively reviewed recorded data of patients who were randomized into two groups according to medical treatment as tamsulosin monotherapy and tamsulosin with dutasteride combination therapy between June 2002 and February 2008. A total of 150 patients who were initially admitted to the emergency department for BPH-associated AUR were selected. The urethral catheters were removed at the end of 3 days, and 96 patients who had a post-void residual urine volume of <150 mL were included in the study. Patients were followed up in an interval of 3 months; the primary endpoint was time to BPH-related surgery. Logistic regression was used to determine factors that contribute to BPH-related surgery. Furthermore, we compared the groups in terms of post-treatment variables.
Results:
Of the patients, 26 (27%) were diagnosed with prostate cancer and excluded from the study. A total of 70 patients, 38 in the monotherapy and 32 in the combination groups, participated in the study and were followed up for 1 year. The comparison of the monotherapy group and the combination group showed that the BPH-related surgery ratio (p=0.005) and serum total prostate- specific antigen (PSA) level (p=0.013) were lower in the combination group. By multivariate logistic regression analysis, we found that older age, higher serum PSA level, and higher prostate volume were independently associated with BPH-related surgery.
Conclusion:
Of all the factors analyzed, prostate volume, age, and serum PSA level were the most accurate predictors of BPH-related surgery. Moreover, combination treatment was found to be more effective treatment choice for prevention of BPH-related surgery.
Keywords: Benign prostate hyperplasia, alpha blockers, acute urinary retention