Background and Importance Hospitalised patients often require indwelling urinary catheters due to urinary retention, surgery, or other reasons, and catheterisation may increase the risk of catheter-associated urinary tract infection (CAUTI) and death. Alpha-blockers can reduce muscle tension and relieve dysuria in patients with benign prostatic hyperplasia (BPH). However, there is considerable uncertainty about whether alpha-blockers aid in catheter removal.

Aim and Objectives To assess the effectiveness of alpha-blockers on successful resumption of micturition after removal of a short-term urinary catheter in adults.

Material and Methods We searched PubMed, Embase and Cochrane databases from 1983 to July 2023 for all randomised controlled trials (RCTs). No language or other restrictions were imposed on the searches. Two review authors independently screened the titles and abstracts of each trial before obtaining the full text for all potentially eligible trials and assessed the included trials for risk of bias. A random-effects meta-analysis was applied to pool event rates with 95% confidence intervals (CIs). We made appropriate clinical treatment recommendations by GRADE Evidence to Decision (EtD) frameworks.

Results A total of 33 RCTs were included with 14 studies in the non-surgical group and all patients with BPH. There was high quality evidence to suggest that the rate of successful trial without catheter (TWOC) favoured alpha-blockers over placebo (odds ratio [OR], 2.2; 95% CI:1.6–3.0). There was moderate quality evidence to reduce the risk of requiring re-catheterisation (OR: 0.5; 95% CI: 0.3–0.7). There was low quality evidence to reduce the incidence of recurrent urinary retention (OR: 0.2; 95% CI: 0.1–0.7 ). In 19 studies with BPH and non-BPH patients undergoing surgery, there was moderate quality evidence to reduce the risk of postoperative urinary retention (POUR) regardless of gynaecological surgery.

Conclusion and Relevance We strongly recommend patients with a history of BPH or suspected with BPH to accept prophylactic alpha-blockers before catheter removal. Surgical patients are moderately recommended using alpha-blockers to prevent POUR. As for other patients, we must evaluate many factors such as age, gender, medical history, risk of adverse effects, previous urinary catheter experience and indications of indwelling urinary catheters before alpha-blockers application.

Conflict of Interest No conflict of interest.