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

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.

Treatment

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
 note 

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

Tamsulosin
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Alfuzosin (Xatral)
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Second Choice  
   
Dutasteride and Tamsulosin (Combodart)
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Key
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Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

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]   

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