Postoperative urinary retention (POUR) is one of the common complications of surgery and anesthesia. Alpha-adrenergic receptor blockers may prevent or reduce POUR. The aim of this study is to conduct a systematic review and meta-analysis on the effects of alpha-adrenergic blockers in female patients with POUR.

A systematic literature search was conducted using different databases from their earliest record to July 2022 only with English language. All randomized control trials examining the effects of alpha-adrenergic blockers in female patients with POUR after any type of surgery were included. The studies which were not randomized control trials, were not published in English, and did not report results specifically for female patients were excluded. All statistical analyses were performed using RevMan, version 5.4.

Postoperative urinary retention (POUR)
A total of 120 POUR cases were observed among 475 female patients. There were 40 cases of urinary retention among 236 patients who received alpha-blockers treatment. In the control group with 239 patients, 80 cases of urinary retention were reported. The treatment group experienced a significant lower incidence of POUR than the control group, OR=0.39 (95%CI:0.17;0.89, p-value = 0.03). 

Urinary tract infection (UTI)
Three studies with a total of 27 cases reported UTI. Nine cases and 18 cases of UTI were reported in the treatment group and control group respectively though the difference was not significant, OR = 0.46 (95% CI:0.19; 1.11, p-value = 0.09).

Postoperative postvoid residual urine volume (PVR)
Two studies also examined the effects of alpha-adrenergic blockers on postoperative PVR. The study conducted with phenoxybenzamine showed a postoperative PVR mean volume of 70 ml in the treatment group and 232 ml in the placebo group on the fifth postoperative day, and the difference was significant (p-value= 0.018). Another study conducted with indoramin showed a postoperative PVR mean volume of 251 ml in the treatment group and 325 ml in the placebo group on the first postoperative day, but the difference was not significant (p-value = 0.49).

Female patient who received alpha-adrenergic blockers were 61% less likely to experience POUR than those who received placebo. However, alpha-adrenergic blockers may not have a significant effect on the reduction of developing postoperative UTIs in female patients. For postoperative PVR, the findings may not be generalizable to time points, and more research is needed to confirm these results.

This study showed a significant risk reduction of POUR in female patients by using alpha-adrenergic blockers. This may become useful in the management of POUR in female patients not only to avoid the comorbidity of POUR itself but also to reduce catheterization-related problems.