Does prophylactic tamsulosin use with ERAS protocol provide improvement after colorectal surgery?

Abstract

Introduction: Early urinary catheter removal has been incorporated into Enhanced Recovery After Surgery (ERAS) pathways to aid faster recovery and minimize urinary tract infection. However, early catheter removal can result in urinary retention, which may lead to catheter reinsertion and a prolonged hospital stay. Tamsulosin, an alpha-blocking medication, effectively treats urinary retention in both men and women. Our study aims to compare urinary retention rates and short-term outcomes between patients treated with tamsulosin and those who were not.

Methods: This retrospective cohort study included patients who underwent elective abdominopelvic colorectal procedures using the ERAS protocol between September 2020 and October 2023. After April 2022, postoperative 0.4 ​mg tamsulosin treatment was added to the ERAS protocol. Univariate analysis was used to compare demographics and perioperative treatment history. The control and tamsulosin groups were matched in a 2:1 ratio, using propensity scores. The primary outcomes were urinary retention and the length of hospital stay.

Results: The study included 2072 patients (1215 female, 58.6 ​%), with a mean age of 53.1 (±17.1) years. The initial univariate analysis was followed by propensity score matching, resulting in 344 patients in the tamsulosin group and 688 in the control group. The urinary retention rate was notably lower in patients who received tamsulosin during hospitalization (9.2 ​% vs. 4.7 ​%, p ​= ​0.01). Furthermore, the length of hospital stay was shorter in patients treated with tamsulosin (5 vs. 4.2 p ​< ​0.01).

Conclusion: Postoperative prophylactic tamsulosin use decreases urinary retention rates and length of stay after colorectal surgery and should be considered complementary to ERAS protocols for improved recovery.