Efficacy and safety of α1-adrenergic receptor antagonists in managing acute urinary retention secondary to benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE(S): Acute urinary retention (AUR) is a common consequence of progressive symptoms in patients with benign prostatic hyperplasia (BPH), with an incidence of approximately 6.8 episodes per 1,000 individuals per year. This study aims to evaluate the effectiveness of α1-adrenergic receptor antagonists in improving the success rate of trial without catheter (TWOC) following episodes of AUR. Material and method(s): This systematic review and meta-analysis were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) 2020 statement, and the protocol was registered in PROSPERO (ID: CRD420251127772). A detailed literature search was run in PubMed, Cochrane Library (CENTRAL), and Google Scholar. RESULT(S): The meta-analysis of 8 randomized controlled trials showed that treatment with α1-adrenergic receptor antagonists significantly improved the likelihood of successful trial without catheter (TWOC) as compared with placebo, with a pooled risk difference of 24.5% (95% CI: 18.4-30.7, p < 0.0001). CONCLUSIONS: α1-Adrenergic receptor antagonist therapy significantly improves short-term voiding success following AUR due to BPH and appears to reduce recurrence without a significant increase in adverse events. These findings support the routine use of α1-blockers as part of initial management before TWOC in men with AUR secondary to BPH.