Poster Abstracts / JAMDA 13 (2012) B3eB13
Tamsulosin (“Flomax”) Use for Women with Bladder Outlet Obstruction in the Nursing Home: Demonstrative Cases,
and Examples of the Benefit of Collaborative Work Between Geriatricians, Nurses and a Consulting Urogynecology
Nurse Practitioner
Presenting Author: Liesbeth Tryzelaar, MD, Baystate Medical Center Geriatrics
Author(s): Liesbeth Tryzelaar, MD,
Martha Klay, RN, MSN, ARNP, Sandeep Sharma, MD; and Sandra Bellantonio, MD
Introduction: Incontinence is present in more than half of all nursing residents. It is associated
with falls, urinary tract infections, pressure ulcers and dermatitis. Tamsulosin (“Flomax”), an
alpha blocking agent commonly used in men with benign prostatic hyperplasia, has been used in
women with functional or anatomical bladder outlet obstruction, but its use is controversial,
because there are few high quality studies documenting its efficacy in women. The use of this
agent has been rarely described in the literature in female residents of long-term care facilities.
The following are two examples of its use in nursing homes.
Case Description: Case 1: 74 year
old woman with moderate dementia admitted from home because of need for increased
supervision. During her admission at the nursing home she developed more frequent episodes of
urinary incontinence. She was diagnosed and treated for two urinary tract infections. About nine
months after admission, a urogynecology nurse was con- sulted. The patient complained of
urinary obstructive symptoms and was started on a regimen of treatment including tamsulosin. In
addition geriatrics staff reviewed the case and recommended stopping nortriptyline, which the
patient was taking for depression. The tamsulosin was well-tolerated, and the patient had
decreased daytime incontinence. Case 2: 84 year old woman with a history of weight loss, urinary
incontinence, constipation, and groin discomfort, was referred for evaluation to a urogynecology
nurse. The patient was found to have a posterior pelvic mass associated with urinary retention.
The urogynecology nurse recommended interventions including a pelvic ultrasound, a bowel
regimen and tamsulosin. The patient was found to have a pelvic mass which was likely a
malignancy; she and her family decided to pursue palliative management. On a bowel regimen
and alpha blocker the urinary retention and constipation improved. The patient expired, but staff
and the patient's family felt her quality of life had improved with amelioration of her bladder
obstruction.
Discussion: Tamsulosin (“Flomax”) is an alpha-blocker, thought to function at the bladder neck,
leading to improved urine flow. Its use is controversial in women: there are few high quality
studies involving women and many geriatricians have concerns about the potential side effects
(e.g. orthostatic hypotension, increased congestive heart failure incidence). Tamsulosin has been
recom- mended by many urologists in certain women with functional or anatomical bladder outlet
obstruction, but its use has been rarely described in older women in nursing facilities.
Author Disclosures: All authors have stated there are no disclosures to be made that are pertinent
to this abstract.