Instances of Acute Urinary Retention Seen With Use of COX-2 Inhibitors

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Instances of Acute Urinary Retention Seen With Use of COX-2 Inhibitors

By J. Brown, MD

NEW YORK (Reuters Health) Sept 19 - Three case reports suggest that use of

cyclooxygenase-2 (COX-2) inhibitors may cause acute urinary retention.

However, this adverse effect may be limited to patients who already have

impaired bladder function.

Dr. Gruenenfelder and colleagues, from the University of Michigan

Medical Center in Ann Arbor, describe three elderly patients who developed

acute urinary retention after being treated with COX-2 inhibitors for

arthritis pain.

The first patient, an 89-year-old woman with multiple medical problems,

presented to the emergency room complaining of low urine output, poor

urinary stream, and urinary incontinence. Two days prior to symptom onset,

the patient had begun taking rofecoxib for shoulder pain. A urinary catheter

was placed to facilitate voiding. Upon removal of the catheter 4 days later

the patient was able to void to completion.

The second case involved a 72-year-old woman who developed urinary retention

while being hospitalized for ischemic heart disease. Five days prior to

hospital admission, the patient began taking rofecoxib for lower extremity

joint pain. Twenty-four hours after stopping the rofecoxib therapy, the

patient's urinary retention resolved.

The third patient was a 75-year-old man who experienced a worsening of lower

urinary tract symptoms after taking celecoxib for arthritis pain. Once

again, a normal voiding pattern returned after celecoxib was discontinued.

All of the patients had comorbidities that can cause bladder dysfunction,

the authors note. " We believe that the addition of a COX-2 inhibitor further

relaxed the detrusor muscle, resulting in urinary retention, " they add. Such

agents probably do not cause retention problems in patients with normal

bladder function, but they should nevertheless be considered in the

differential diagnosis, Dr. Gruenenfelder and colleagues advise.

Merck & Co, Inc., manufactures rofecoxib under the trade name Vioxx. " From

our clinical trials involving thousands of patients, there has been no

evidence that rofecoxib increases the risk of acute urinary retention, " Dr.

Alan Goldberg, a medical director with Merck, told Reuters Health. " Our

post-marketing experience with the drug has also failed to show any

increased risk of the condition. "

Dr. Goldberg noted that " from a mechanistic standpoint, it is plausible that

drugs that reduce prostaglandin levels could produce urinary retention. "

However, " oftentimes what makes sense scientifically, isn't clinically

apparent, " he added.

J Urol 2002;168:1106.

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