{ "schema_version": 1, "kind": "condition", "id": "urinary-retention", "name": "Urinary retention", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class US04 - condition scope only, no dose · Male Urinary Retention: Acute and Chronic - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538499/ · Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20)", "review_status": "reviewed", "verified_against": "Urinary retention - disease-level clinical article (urinary-retention-full.txt) · Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20)", "verified_date": "2026-08", "treatments": [ { "id": 1818, "generic": "Tamsulosin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.4, "adult_dose": "0.4 mg once daily, modified-release capsule; the article allows up to 0.8 mg", "adult_duration": "Start at the time of catheterisation; it needs 72 hours for full effect, and continues afterwards", "dose_source": "Egyptian National Drug Formulary - Cardiovascular (tamsulosin monograph, p20)", "rationale": "THE CATHETER COMES FIRST - the cited article puts immediate bladder decompression with a 16-French Foley ahead of any drug, and says rapid complete drainage is best even for a very large bladder. The drug is what makes the catheter removable. The article names alpha-blockade as the primary first-line medical therapy for retention caused by benign prostatic enlargement, especially over 60, and says a man in acute retention who is not already on one should be started on one, and a man already on one should have the dose maximised. The formulary's tamsulosin monograph names benign prostatic hyperplasia as its indication and gives 0.4 mg daily as the modified-release capsule dose.", "cautions": [ "THE DRUG DOES NOT EMPTY THE BLADDER. Catheterise first. If the urethra cannot be passed - and after recent prostatectomy or urethral reconstruction it must not be attempted - a suprapubic tube is needed urgently.", "IT TAKES 72 HOURS to reach full effect, which is why the trial of voiding is not attempted before then.", "The formulary states plainly that tamsulosin is NOT indicated for hypertension. It still drops the blood pressure on standing, particularly with the first dose and in the elderly.", "Warn any man due for cataract surgery, and tell his ophthalmologist: alpha-blockers cause intraoperative floppy iris syndrome, and the surgeon must know before the operation, not after.", "DO NOT GIVE PROPHYLACTIC ANTIBIOTICS with the catheter. The article is explicit that they have been shown not to prevent infection and drive resistance. Treat an infection only if there is one.", "Alfuzosin 10 mg daily and silodosin 4-8 mg daily are the equally effective alternatives in the article. Doxazosin and terazosin work as well but drop the standing blood pressure more and have to be titrated up, so the article does not recommend them for acute retention." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a paediatric drug. Retention in a child is a different problem with different causes and belongs with a paediatric surgeon or urologist.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "NORMIRAMA 0.4 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > RAMAPHARMA", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TAMSUNORM S.R. 0.4MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TAMSULOSIN 0.4 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE > SANDOZ", "price_egp": 42.0, "pack_count": 20, "unit_price": 2.1, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CUREPRO XR 0.4 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > KHUFU PHARMA", "price_egp": 105.0, "pack_count": 30, "unit_price": 3.5, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BLOCK ALPHA 0.4 MG MR 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 120.0, "pack_count": 30, "unit_price": 4.0, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FIRAMAZIN 0.4MG 30 H.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMNIC 0.4MG 30 MODIFIED RELEASE CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTELLAS PHARMA > MULTIPHARMA", "price_egp": 147.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OMNIC OCAS 0.4 MG 30 PROLONGED RELEASE F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASTELLAS PHARMA INC > MULTIPHARMA", "price_egp": 282.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "urinary-retention" }, { "id": 1820, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Common in older men with prostate enlargement; the GP recognises acute retention, may attempt catheterisation or refer, and starts medication for underlying benign prostate enlargement.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Common in older men with prostate enlargement; the GP recognises acute retention, may attempt catheterisation or refer, and starts medication for underlying benign prostate enlargement.", "cautions": [ "Acute painful urinary retention is a urological emergency needing prompt catheterisation and referral.", "The referral is urological and it still stands. The alpha-blocker above is the exception: it is started in primary care at the time of catheterisation, because it is what decides whether the catheter can come out.", "RED FLAG - Urinary retention accompanied by back pain, sciatica, lower extremity weakness, saddle anesthesia, or bowel dysfunction indicates cauda equina syndrome requiring immediate MRI and emergency surgical evaluation.", "RED FLAG - Large post-void residual urine volumes (>1500 mL), acute renal failure, or electrolyte imbalances carry high risk for post-obstructive diuresis requiring hospital admission." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "urinary-retention" }, { "id": 1819, "generic": "Finasteride", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "5 mg once daily", "adult_duration": "At least 6 months for full effect; over a year to reduce future retention and surgery", "dose_source": "Male Urinary Retention: Acute and Chronic - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK538499/", "rationale": "This is prevention, not treatment of the episode in front of you. The cited article says finasteride or dutasteride shrinks the prostate by about 20-25% and lowers the chance of a further episode of acute retention, but needs at least 6 months to work and helps most where the prostate is over 30 g. Added as an adjunct beside the alpha-blocker, never instead of it.", "cautions": [ "IT DOES NOTHING FOR THE EPISODE IN FRONT OF YOU. Six months to full effect. The catheter and the alpha-blocker are what relieve today's retention.", "IT HALVES THE PSA. The article notes a roughly 50% reduction; a PSA taken on finasteride has to be doubled before it is interpreted, or a prostate cancer is missed.", "A woman who is or may become pregnant must not handle crushed or broken tablets - the drug harms a male fetus.", "Warn about the sexual side effects before starting, not after: reduced libido, erectile difficulty and reduced ejaculate." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a paediatric drug.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MIXOSTERIDE 5 MG 14 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > PHARMA MIX", "price_egp": 30.0, "pack_count": 14, "unit_price": 2.14, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FINCAR 5MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 26.4, "pack_count": 10, "unit_price": 2.64, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROSTAT 5MG 14 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID > OCTOBER PHARMA", "price_egp": 46.0, "pack_count": 14, "unit_price": 3.29, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROSTEC 5 MG 14 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 47.0, "pack_count": 14, "unit_price": 3.36, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FINASTURA 5MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ROYALSTERIDE 5 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM > ROYAL LINK PHARMA", "price_egp": 132.0, "pack_count": 30, "unit_price": 4.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROSTRIDE 5MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 183.0, "pack_count": 30, "unit_price": 6.1, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROSCAR 5MG 28 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MERCK SHARP & DOHME > MERCK SHARP & DOHME SCIENTIFIC OFFICE", "price_egp": 258.0, "pack_count": 28, "unit_price": 9.21, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "urinary-retention" } ] }