TEMPOUR: A Randomized Controlled Trial Assessing Perioperative Use of An Alpha-1-Blocker to Reduce Postoperative Urinary Retention Following Transanal Endoscopic Microsurgery Procedures.

Abstract

Background: Transanal endoscopic microsurgery is a treatment option for a wide range of rectal lesions. Postoperative urinary retention is a frequently associated complication. Some studies have suggested that the use of alpha-1-blockers may reduce the risk of postoperative urinary retention after hernia and colorectal surgery, but evidence is lacking.

Objective: This trial aims to evaluate if prophylactic use of an alpha-1-blocker reduces the rate of postoperative urinary retention following transanal endoscopic microsurgery.

Design: Double-blind, placebo-controlled trial.

Settings: Single high-volume Canadian colorectal center.

Patients: Adult male patients awaiting transanal endoscopic microsurgery and not on alpha-1-blocker were included.

Intervention: Patients were allocated to either Tamsulosin or placebo from 5 days prior to surgery to 2 days postoperatively.

Main outcomes measures: The primary outcome was the incidence of post-operative urinary retention. Secondary outcomes were urinary retention-related hospitalization, time to removal of bladder catheter and International Prostate Symptom Score, before and after treatment, and adverse events.

Results: 158 patients were randomized between October 2017 and July 2022. There was no significant difference in postoperative urinary retention between groups (23% vs 14%; p = 0.16) respectively in the tamsolusin and placebo groups. Time to removal of bladder catheter was not statistically different between groups (4.8 vs 8.6 days, p = 0.26). No failure of same-day discharge, nor readmissions related to urinary retention occurred. International Prostate Symptom Scores were not significantly different at the time of surgery (3.8 vs 5.4; p = 0.11) and reported adverse events did not differ between groups.

Limitations: We cannot exclude a potential type II error.

Conclusion: Prophylactic use of an alpha-1-blocker for patients undergoing transanal endoscopic microsurgery was not associated with a reduction in post-operative urinary retention. See Video Abstract.

Trial registration: ClinicalTrials.gov Identifier: NCT03314025.