Management of Urinary Retention and Lower Urinary Tract Symptoms in BPH

Treatment of Acute Urinary Retention

The American Urological Association recommends immediate urethral catheterization for bladder decompression, followed by an alpha blocker (tamsulosin 0.4 mg or alfuzosin 10 mg), and attempting trial without catheter (TWOC) after 3+ days of therapy, with expected success rates of 60% with alfuzosin, 47% with tamsulosin, versus 29-39% with placebo 1, 2
Alpha blockers, such as tamsulosin or alfuzosin, are the recommended first-line treatment for acute urinary retention due to BPH, not tadalafil 1, 2

The American Urological Association recommends tadalafil 5 mg daily for moderate to severe LUTS/BPH (IPSS ≥13) in men who have NOT progressed to acute urinary retention, with a mean IPSS reduction of -5.4 to -5.6 points compared to -3.6 points with placebo 3
Tadalafil 5 mg daily is also recommended for the combination of LUTS/BPH and erectile dysfunction, as it treats both conditions simultaneously 3

The American Urological Association recommends against combining tadalafil 5 mg with alpha blockers, as this combination offers no additional symptom benefit over either agent alone and increases side effects 1, 3
Concomitant nitrate use is an absolute contraindication for tadalafil due to the risk of severe hypotension 3