An alpha-blocker before trial without catheter raised success by about a quarter

The edition in brief

A meta-analysis of eight randomised trials in men with acute urinary retention from benign prostatic hyperplasia found that an alpha-blocker before trial without catheter raised the chance of voiding successfully by an absolute 24.5 percentage points (95% CI 18.4 to 30.7) compared with placebo, without a notable rise in side effects. That supports starting one routinely at catheterisation. In the LURN cohorts of 2118 adults, urgency syndromes were associated with about three times the odds of vascular disease compared with controls, and among men, erectile dysfunction affected 64% of those with urgency incontinence against 29% of controls — reason to ask about cardiovascular risk when urgency incontinence appears. A post hoc analysis of the ARASENS and LATITUDE trials found testosterone rising above 35 ng/dL on intensified therapy for metastatic hormone-sensitive prostate cancer was associated with worse survival in LATITUDE (HR 1.49) but not significantly in ARASENS; it is exploratory and sets no testosterone target. A cohort of 1938 men on active surveillance for Grade Group 1 prostate cancer linked larger prostates and 5-alpha reductase inhibitor use with lower rates of grade progression and definitive treatment. The pearl covers what to check when a man presents in retention.