Study links COPD drugs to risk of urinary emergency in men

Having the urge to urinate -- and not being able to do so -- is painful, as many men know. Now a study suggests that certain medications may make the emergency form of this condition, known as acute urinary retention, more likely.

The news may not come as a complete surprise. Painful urination or difficulty urinating are listed as possible side effects of the drugs studied – sold under the names Atrovent, Combivent and Spiriva. But the new study tries to quantify the risk of emergency urinary problems associated with the drugs.

Using a database of 565,073 Canadians with chronic obstructive pulmonary disease, researchers from St. Michael’s Hospital in Toronto identified 9,432 men and 1,806 women who had developed acute urinary retention. Men who had just started taking inhaled anticholinergic medications, a common treatment for the breathing disease, had 42% greater odds of developing the urinary problem than men who were not on anticholinergics.

The risk was even greater for men with enlarged prostates or who took both short- and long-acting types of the medication. The researchers didn’t find an increased risk of the condition in women taking the medications. The results were published here in the Archives of Internal Medicine.


The National Institute of Diabetes and Digestive and Kidney Diseases explains how acute urinary retention can occur:

“Urinary retention can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not get the message that the bladder is full. Even if you know that your bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax.”

Chronic obstructive pulmonary disease, or COPD, is a progressive disease – often caused by smoking -- that makes breathing difficult. About 12 million people have it, according to an explainer by the National Heart Lung and Blood Institute.

The primary medical treatment is explained in this Mayo Clinic article:

“Short-acting bronchodilators, both beta agonists and anticholinergics are the mainstay of medication therapy for COPD. These medications often provide rapid relief of symptoms (particularly shortness of breath).”

But it appears the drugs might be associated with an increased risk of acute urinary retention. In one way of looking at the numbers from the study, the increased risk is actually quite small. According to this WebMD article:

“Researchers calculated that 514 men with COPD and enlarged prostates would need to take these kinds of inhaled bronchodilators for one man to experience acute urinary retention within 30 days of starting the medication. After six months of treatment, however, that number drops to one in 263 men.”

The study authors themselves say, quite simply: “We suggest that the association between respiratory inhaler use and bladder dysfunction may be underappreciated by the medical profession and by the public.”


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