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A 3.3-fold increase in acute urinary retention was found in new male users of nonsteroidal anti-inflammatory drugs (NSAIDs) compared to non-users in a large primary care database from the Netherlands. The risk for all male NSAID users was 2.3-fold greater.
NSAIDs May Cause Urinary Retention
October 30, 2005 3 minutes read
NSAIDs May Cause Urinary Retention
Abstract & Commentary
By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.
Synopsis: A 3.3-fold increase in acute urinary retention was found in new male users of nonsteroidal anti-inflammatory drugs (NSAIDs) compared to non-users in a large primary care database from the Netherlands. The risk for all male NSAID users was 2.3-fold greater.
Source: Verhamme KM, et al. Nonsteroidal anti-inflammatory drugs and increased risk of acute urinary retention. Arch Intern Med. 2005:165;1547-1551.
A search for acute urinary retention from 1995-2002 in all men aged 45 years or older tracked in the Netherlands Integrated Primary Care Information Project for at least 6 months found 536 cases out of a source population of 72,000 men. The database contains information on 500,000 patients from 150 general practitioners in the Dutch health system which uses a gatekeeper approach for medical care. These cases were matched for age and date of the urinary retention diagnosis with 10 male controls from the same population who had no record of using the drugs studied.
Prescription records for all NSAIDs, COX-2 inhibitors, and aspirin were matched to cases and controls if they were received within 1 week prior to the date, or had been used within the prior 6 months.
The overall increased risk for acute urinary retention was 2.3 compared to non-users. For current users, the risk was highest at 3.3 when the prescription was new within the prior week, compared to 1.8 for long-term users. Past use alone was not associated with any risk. Medication doses less than the recommended average daily dose as defined by the World Health Organization were also not associated with increased risk. COX-2 inhibitors had a risk slightly above the non-selective NSAIDs, although this was not statistically significant. Aspirin use alone was not associated with increased risk.
The patients identified with acute urinary retention had higher comorbidities such as BPH, prostate cancer, neurologic disorders and prior UTIs. They also were using more anticholinergic drugs, narcotics, and benzodiazepines when compared to controls.
Commentary
Prostaglandins are known to have an important role in urinary function, with synthesis in the bladder via the COX-2 pathway and involvement in the contractions that empty the bladder. One published case report of 3 patients suggested that starting treatment with COX-2 inhibitor drugs precipitated acute urinary retention.1
The Netherlands researchers searched their database for this association, and found not only that COX-2 inhibitors were associated with the new onset of acute urinary retention, but that the association with starting any NSAID treatment except aspirin had an even greater risk. Higher dosages carried more risk (although it was not a linear relationship), and acute urinary retention occurred most often with recent onset of NSAID therapy.
They did not find an association of acute urinary retention with daily aspirin therapy, another prostaglandin inhibitor, which they attributed to its use mainly in low doses for cardiac protection.
Although the risk found here is only an association and not definitively proved as a cause, and like all medical cases there were many other factors involved, this information nonetheless should make us all more alert to signs of urinary problems when we initiate NSAID therapy, particularly in high-risk patients.
Reference
1. Gruenenfelder J, et al. Acute urinary retention associated with the use of cyclooxygenase-2 inhibitors. J Urol. 2002;168:1106.
A 3.3-fold increase in acute urinary retention was found in new male users of nonsteroidal anti-inflammatory drugs (NSAIDs) compared to non-users in a large primary care database from the Netherlands. The risk for all male NSAID users was 2.3-fold greater.Article Limit Reached
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