Patients with acute urinary retention (AUR) due to benign prostatic obstruction can be treated safely with a combination of tamsulosin and ketoconazole to achieve a better success with trial without catheter (TWOC), according to investigators.

Mohamed A. Elbendary, MD, and collaborators at Tanta University in Tanta, Egypt, studied 106 men with a mean age of 64 years and a mean prostate size of 61.6 grams. Following urethral catheterization, the team randomized participants into two equal groups. 

One group received tamsulosin 0.4 mg once daily and ketoconazole 200 mg three times a day and the other group received tamsulosin and placebo for seven days. The patients were then placed on a TWOC. The incidence of successful TWOC was significantly higher in the combined treatment group compared with the tamsulosin group (77.3% vs. 58.9%), the researchers reported online ahead of print in Prostate Cancer and Prostatic Disease.

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Among subjects who had a successful TWOC, the peak flow rate and the post-void residual volume were also significantly better in the combined treatment group compared with the placebo arm.

All patients tolerated both medications well and no patients discontinued treatment, according to the researchers.

The investigators noted that they studied the use of ketoconazole in treating AUR due to benign prostate obstruction because the drug can lower serum testosterone to castration levels within 48 hours and the prostate is an androgen-dependent organ.