netFormulary George Eliot Hospital NHS
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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
The development of this chapter for the George Eliot Formulary is in progress
07.04.01  Expand sub section  Drugs for urinary retention

NICE CG97: Lower urinary tract symptoms in men: management

Urinary retention is the inability to voluntarily urinate. It may be secondary to urethral blockage, drug treatment (such as use of antimuscarinic drugs, sympathomimetics, tricyclic andtidepressants), conditions that reduce detrusor contractions or interfere with relaxation of the urethra, neurogenic causes, or it may occur postpartum or postoperatively.

Acute urinary retention is a medical emergency characterised by the abrupt development of the inability to pass urine (over a period of hours). Chronic urinary retention is the gradual (over months of years) development of the inability to empty the bladder completely, characterised by a residual volume greater than one litre or associated with the presence of a distended or palpable bladder.

The most common cause of urinary retention in men is benign prostatic hyperplasia. Men with an enlarged prostate can have lower urinary tract symptoms associated with obstruction, such as urinary retention (acute or chronic), frequency, urgency or nocturia.


Acute urinary retention is painful and requires immediate treatment by catheterisation. Before the catheter is removed and alpha-blocker should be given for at least two days to manage acute urinary retention.

In male patients with chronic urinary retention whose symptoms are bothersome, drug treatment should only be offered when other conservative management options have failed. Men with moderate to severe symptoms should be offered an alpha-blocker. Treatment should initially be reviewed after 4-6 weeks and then every 6-12 months.

07.04.01  Expand sub section  Alpha-blockers

Alpha-blockers relax the smooth muscle in the prostate gland and at the base of the bladder, making it easier to pass urine.

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First Choice  
Alfuzosin (Xatral)
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Second Choice  
Dutasteride and Tamsulosin (Combodart)
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Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]