An alpha-blocker before catheter removal raised trial-without-catheter success by about 25 points

The edition in brief

A meta-analysis of eight randomised trials found that alpha-1 blockers given for acute urinary retention due to benign prostatic hyperplasia increased successful trial without catheter compared with placebo by an absolute 24.5 percentage points (95% CI 18.4–30.7), with no clear rise in adverse events. A systematic review of five randomised screening trials (721,607 men, 11–23 years' follow-up) concluded with high certainty that PSA-based screening reduced prostate cancer mortality among those who engage in screening, with the relative benefit growing with longer follow-up; the authors stress this does not by itself justify population screening. A single-surgeon randomised trial of 248 patients found sutureless off-clamp robotic partial nephrectomy non-inferior to renorrhaphy for the Trifecta outcome (93% vs 95%), with slightly more urinary fistulae. A pilot trial of 50 women with recurrent uncomplicated urinary infection found fewer recurrences with the probiotic E. coli Nissle 1917 than placebo (16.7% vs 42.3%, RR 0.39, 95% CI 0.14–1.14), not statistically significant. The pearl lists established non-antibiotic options for preventing recurrent urinary infections.