NSAID Painkillers May Raise Urinary Retention Risk

But experts disagree about the seriousness of the problem

MONDAY, July 11, 2005 (HealthDay News) -- Using nonsteroidal anti-inflammatory drugs (NSAIDS) may double the risk of developing acute urinary retention, Dutch researchers report.

Urinary retention involves the abnormal holding of urine within the bladder, often due to bladder muscle failure.

The new finding, which involves ibuprofen, naproxen (Aleve) and the cox-2 inhibitor Celebrex, adds to highly publicized cardiovascular issues surrounding the use of these popular medications.

Both Vioxx and Bextra were pulled from the market after studies pointed to increased risks for heart attack and stroke with cox-2 inhibitor use. As a result, the FDA mandated warning labels on all similar prescription drugs and label changes on similar over-the-counter ones.

Earlier case reports had also suggested that NSAIDS may increase the risk of acute urinary retention by affecting the production of prostaglandin, a hormone essential in muscle function, researchers report in the July 11 issue of the Archives of Internal Medicine.

In an attempt to define the extent of risk for urinary retention associated with these painkillers, Miriam C. J. M. Sturkenboom, from the Department of Medical Informatics at Erasmus University, Rotterdam, and her colleagues looked at data on more than 72,000 men aged 45 years and older enrolled in the Integrated Primary Care Information project in the Netherlands.

From this large population, the researchers identified 536 cases of urinary retention and compared their use of NSAIDs with that of 5,348 men who did not have the condition.

They found that, among men using NSAIDS, the risk of developing urinary retention was double that of men who didn't take the pain-relieving drugs.

The highest risk was found in men who had recently starting taking NSAIDS, and among men taking the drugs in doses equal to or higher than the recommended daily dose.

"In our study, we found that the risk of acute urinary infection is about twofold higher in patients currently using NSAIDS than in those not taking NSAIDS," the researchers wrote. "We believe that physicians should be informed about the possibility of provoking acute urinary infection in patients using NSAIDS, especially in high-risk patients."

One expert agreed there is scientific evidence to back up these findings. "I have been aware of the effects of cox-2 inhibitors on bladder function for a long time," said Dr. William D. Steers, chairman of the Department of Urology at the University of Virginia Health System. "There is some basic science to suggest that cox-2 inhibitors can relax bladder muscle."

However, Steers isn't sure the Dutch study proves that NSAIDS are the cause of urinary retention. Instead, conditions for which the men were taking the NSAIDS may be to blame. "It would be interesting to actually do bladder testing, to see if these drugs affect urodynamics," Steers said.

Steers also doesn't think the problem is widespread. "Clinically, I'm not sure it's a big deal," he said, because many drugs cause urinary retention.

"People might think this is another nail in the coffin of cox-2 inhibitors, in addition to the recent uproar over them in heart disease," Steers said. "I don't think so."

Another expert advised that doctors take the findings into account when prescribing NSAIDS. "It may be that we should really be quizzing patients on urinary symptoms, as we do when we place patients on cold medication," said Dr. Martin I. Resnick, chairman of the department of urology at Case Western Reserve University.

Resnick believes that patients should be informed of possible urinary side effects of NSAIDS and tell their doctor if they develop any urinary problems while on the drugs.

More information

The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about urinary problems.

SOURCES: William D. Steers, M.D., Hovey Dabney professor of urology and chairman, department of urology, University of Virginia Health System, Charlottesville; Martin I. Resnick, M.D., chairman and professor, department of urology, Case Western Reserve University, Cleveland; July 11, 2005, Archives of Internal Medicine
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