title: Cholinergic drugs for treatment of recurrent urinary retention in high surgical risk/elderly BPH patients. A pilot study.
abstract: OBJECTIVE
  Urinary retention (UR) secondary to benign prostatic hyperplasia often leads patients to surgery, especially those who fail to urinate following a trial without catheter (TWOC). However, patients of high surgical risk and/or elderly patients with co-morbidities are usually not eligible for surgical treatment. Moreover, recurrent UR may indicate a poor detrusor function representing a risk factor of surgical therapy failure. Our objective was to evaluate the role of distigmine bromide, an anticholinesterase agent, to promote a successful TWOC in patients with recurrent UR.
  
  
  METHODS
  Seventeen elderly and/or high surgical-risk patients with recurrent UR and prior failures to TWOCs received a combination of alpha-blocker along with distigmine bromide and have been retrospectively compared with that of 20 first-time UR patients who received only the alpha-blocker just after emergency catheterization. The short-term outcome was measured by resumption of voiding, number of TWOC failures preceding successful voiding, determination of post-voiding residual volume (PVR), and International Prostate Symptom Score (IPSS).
  
  
  RESULTS
  The majority of patients on combination therapy had a successful TWOC, similarly to all first-time urinary retention patients. Compared to patients on monotherapy, patients on combination therapy needed more TWOCs to void due to gradual increase in the dosage of distigmine bromide. PVR was significantly reduced with treatment in both groups. Statistically, there was no significant difference between the two groups on the PVR and IPSS mean change.
  
  
  CONCLUSIONS
  Our results suggest that the combination of alpha-blocker and distigmine may eventually benefit patients with recurrent UR and prior unsuccessful TWOCs, to void.
authors.affiliation: Second Department of Urology, Athens University Medical School, Athens, Greece. stamatiouk@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Skolarikos
authors.forename: S
authors.initials: S
authors.lastname: Tyritzis
authors.forename: K
authors.initials: K
authors.lastname: Stamatiou
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D018678:Cholinergic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications*; D011726:Pyridinium Compounds / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D016055:Urinary Retention / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000317:Adrenergic alpha-Antagonists; D018678:Cholinergic Agents; D011726:Pyridinium Compounds; C084645:distigmine