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July 12, 2005 — Nonsteroidal
anti-inflammatory drugs (NSAIDs) increase the risk of acute urinary
retention (AUR) in men, according to the results of a population-based,
case-control study published in the July 11 issue of the Archives
of Internal Medicine.
"AUR is characterized by the sudden inability to urinate, which
is usually extremely painful and requires catheterization," write
Katia M.C. Verhamme, MD, from Erasmus MC in Rotterdam, the Netherlands,
and colleagues. "Prostaglandins play an important role in the genitourinary
function as they provoke contractions of the detrusor muscle....
As NSAIDs are known to have a direct effect on prostaglandin synthesis,
they have been tested in clinical trials for the treatment of detrusor
instability."
This study included all men age 45 years or older with at least
six months of valid database history who were registered between
1995 and 2002 with the Integrated Primary Care Information (IPCI)
project in the Netherlands. Within this population of 72,114 men,
there were 536 cases of AUR, defined as all men with a validated
diagnosis of AUR, and 5,348 control subjects matched by age and
calendar time.
Compared with nonusers of NSAIDs, current users of NSAIDs had
a risk of AUR 2.02-fold higher (95% confidence interval [CI], 1.23
- 3.31). Patients who recently started taking NSAIDs at a dose
equal to or higher than the recommended daily dose had the highest
risk for AUR (adjusted odds ratio [OR], 3.3; 95% CI, 1.2 - 9.2).
Study limitations include exposure assessment based on longitudinally
collected general practitioner prescriptions rather than on dispensing
or patient-reported intake; failure to include use of over-the-counter
medications; possibly underestimated risk; and confounding by indication.
"This study shows that the risk of AUR is about twofold higher
in men who use NSAIDs," the authors write. "We believe that physicians
should be informed about the possibility of provoking AUR in patients
using NSAIDs, especially in high-risk patients."
The authors report no financial disclosures.
Arch Intern Med. 2005;165:1547-1551
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