Additive Value of Pyridostigmine to Silodosin in the Management of Acute Urinary Retention Secondary to Benign Prostatic Hyperplasia: A Randomized Controlled Trial

TL;DR

Adding pyridostigmine to silodosin improves outcomes for men with acute urinary retention due to enlarged prostate.

Contribution

This study demonstrates that combining pyridostigmine with silodosin enhances effectiveness in treating acute urinary retention from benign prostatic hyperplasia.

Findings

82.9% of patients receiving pyridostigmine and silodosin successfully passed a trial without catheter, compared to 67.1% with silodosin alone.

The combination therapy showed significant improvements in symptom scores and urine flow measurements at 2 weeks and 3 months.

Abstract

Background: In men with progressive benign prostatic hyperplasia (BPH), acute urine retention (AUR) stands out as one of the most severe outcomes associated with aging. AUR is characterized by a sudden, painful inability to urinate. This research investigates the potential benefits of adding pyridostigmine to silodosin in the management of acute urinary retention secondary to benign prostatic hyperplasia. Methods: Patients aged 50 and above experiencing their first episode of AUR due to BPH, with a retention volume below 1000 milliliters, were enrolled in this study. A total of 140 patients were randomized into two groups: Group A received a daily dose of pyridostigmine bromide (60 mg tablet) alongside an 8 mg silodosin capsule, while Group B received a daily dose of silodosin (8 mg capsule) only. Trial registration number: NCT06319469 13 March 2024. Results: Among the 140 patients, 58 (82.9%) in Group A successfully underwent a trial without catheter (TWOC), compared to 47 (67.1%) in Group B. Group A exhibited significant improvements in international prostatic symptom score (IPSS) and uroflowmetry (UFR) at both 2 weeks and 3 months, with p-values of 0.001 and 0.003, respectively. Regarding postvoid residual volume (PVR), both groups were initially matched at baseline, showing significant continuous improvement at the second week and third month. Conclusions: The combination of pyridostigmine bromide (60 mg tablet) with silodosin proved to be more effective than silodosin alone in managing acute urinary retention caused by BPH. This was particularly true for patients who were suspected to have detrusor underactivity in addition to BPH.

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