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CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 6-7

Sertraline - Associated acute urinary retention in a patient with benign prostatic hyperplasia


1 Department of Psychiatry, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India
2 Department of Internal Medicine, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India

Date of Submission11-Mar-2018
Date of Decision17-Mar-2019
Date of Acceptance25-Mar-2019
Date of Web Publication26-Feb-2021

Correspondence Address:
Dr. N A Uvais
Department of Psychiatry, Iqraa International Hospital and Research Centre, Kozhikode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jina.jina_16_18

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  Abstract 


Urinary Retention Secondary To The Use Of Selective Serotonin Reuptake Inhibitors Is A Rare Event. We Report The Case Of A Man With Benign Prostatic Hyperplasia (Bph), Who Began To Experience Urinary Retention After Starting Treatment With Relatively Higher Starting Dose Of Sertraline For Panic Disorder. He Required Foley Catheterization And Was Maintained On Indwelling Catheter For 7 Days. Our Report Recommends Monitoring Of Urinary Symptoms In Bph Patients On Sertraline.

Keywords: Benign Prostatic Hyperplasia, Serotonin, Sertraline, Urinary Retention


How to cite this article:
Uvais N A, Mohammed T P. Sertraline - Associated acute urinary retention in a patient with benign prostatic hyperplasia. J Integr Nephrol Androl 2019;6:6-7

How to cite this URL:
Uvais N A, Mohammed T P. Sertraline - Associated acute urinary retention in a patient with benign prostatic hyperplasia. J Integr Nephrol Androl [serial online] 2019 [cited 2021 Aug 1];6:6-7. Available from: http://www.journal-ina.com/text.asp?2019/6/1/6/310179




  Introduction Top


Sertraline Is A Safe And Very Commonly Prescribed Drug Belonging To The Selective Serotonin Reuptake Inhibitor (Ssri) Family. It Has Been Used To Treat Various Psychiatric Disorders Such As Depression, Obsessive-Compulsive Disorder, Panic Disorder, Posttraumatic Stress Disorder, Premenstrual Dysphoric Disorder, And Phobia. Although There Are Reports Of A Higher Rate Of Micturition Problems In Patients Treated With Sertraline, Urinary Retention Is Rarely Reported.[1],[2],[3] Here, We Describe A Case Of Acute Urinary Retention After The Use Of Sertraline In A Male Patient With Benign Prostatic Hyperplasia (Bph).


  Case Report Top


A 50-Year-Old Male, Married, Working As An Accountant In A Private Firm Came To The Psychiatry Outpatient Department With The Complaints Of Palpitation, Worries, Impaired Biologic Function For The Past 1 Month. The Patient Had Multiple Episodes Of The Above Symptoms For The Past 10 Years, Initially Precipitated By Work-Related Stress. Most Of The Past Episodes Were Also Provoked By Work-Related Stress. However, He Never Avoided Duties In Spite Of His Symptoms. Whenever He Became Symptomatic, He Consulted A Local Psychiatrist, Who Diagnosed Him With Panic Disorder And Prescribed Sertraline And Clonazepam, Which Effectively Cured His Symptoms Usually Within A Month. He Used To Continue Those Medications For Longer Periods Irrespective Of Symptoms. However, He Stoped Medications 6 Months Before The Current Episode. The Current Symptoms For The Past 1 Month Were Also Precipitated By Work-Related Stress, For Which He Consulted The Same Psychiatrist And Got Prescribed Oral Sertraline 50 Mg/Day And Oral Clonazepam 0.5 Mg/Day. He Took Sertraline 100 Mg By Mistake On The 1St Day Without Clonazepam. On The Next Day, He Came To The Emergency Department Of Our Hospital With The Complaints Of Difficulty With Urination. Physical Examination By A Hospital Urologist Revealed Suprapubic Sensitivity, Whereas Results Of Blood Chemistry And Urinalysis Were Normal. Ultrasound Examination Of The Urinary System Showed Mild Prostatic Hyperplasia And A Small Amount Of Postvoid Residual Urine In The Bladder. The Foley Catheterization Was Performed To Provide Symptomatic Relief To The Patient And Sertraline Was Stoped. An Indwelling Catheter Was Maintained For 7 Days And Was Removed After A Normal Voiding Trial. Since The Temporal Sequence Of Events Suggested That Sertraline Might Be Causing His Urinary Retention, We Recommended Its Discontinuation And Began Treatment With Oral Clonazepam Alone For His Psychiatric Symptoms. Within 2 Weeks, Most Of His Symptoms Resolved.


  Discussion Top


Although spontaneous acute urinary retention represents one of the most significant and painful events in the natural history of BPH, the temporal relationship with the use of sertraline renders this hypothesis in our case highly unlikely. In the case presented, the patient had an undiagnosed BPH, but was free of any clinically significant urinary outflow symptoms. Introduction of sertraline at a relatively high initial dose seems to have compromised their marginal lower urinary tract outflow and caused reversible acute urinary retention. Naranjo Adverse Drug Reaction scale verified the potential association with a score 5 indicating a probable causal relationship between sertraline use and new-onset urinary retention in our case.[4]

Urinary retention secondary to the use of SSRIs appears to be a rather rare event and is supported only by case reports. We could find three cases of sertraline associated urinary retention in the published literature.[2],[3] All three cases were female. Sertraline precipitated urinary retention in all these cases within 1 week of starting the medication or hiking the dose, and the dose of sertraline was 25–50 mg/day. Another case series reported three cases of escitalopram-associated acute urinary retention in elderly men with known or latent BPH.[5] There are few other reports of urinary retention associated escitalopram and citalopram.[6] Past reports suggest that older adults or pregnant and postpartum women can have higher risks for this complication.

The mechanisms of sertraline-induced urinary retention are not completely known. However, by influencing serotonergic activities in the lower urinary tract, sertraline can exert inhibitory effects on the bladder probably mediated by 5-HT1 receptors.[7] Furthermore, serotonin can increase the central sympathetic outflow leading to urinary storage, and at the same time inhibits parasympathetic flow, which affects voiding.[8]


  Conclusion Top


Our case highlights sertraline's potential association with urinary retention in patients with latent lower urinary tract outflow dysfunction. Physicians should be aware of the possibility of this troublesome adverse effect when prescribing sertraline to these patients with BPH.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cohn CK, Shrivastava R, Mendels J, Cohn JB, Fabre LF, Claghorn JL, et al. Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry 1990;51 Suppl B: 28-33.  Back to cited text no. 1
    
2.
Benazzi F. Urinary retention with sertraline, haloperidol, and clonazepam combination. Can J Psychiatry 1998;43:1051-2.  Back to cited text no. 2
    
3.
Lowenstein L, Mueller ER, Sharma S, FitzGerald MP. Urinary hesitancy and retention during treatment with sertraline. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:827-9.  Back to cited text no. 3
    
4.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.  Back to cited text no. 4
    
5.
Ferentinos P, Margaritis D, Douzenis A. Escitalopram-associated acute urinary retention in elderly men with known or latent benign prostatic hyperplasia: A case series. Clin Neuropharmacol 2016;39:327-8.  Back to cited text no. 5
    
6.
Uher R, Farmer A, Henigsberg N, Rietschel M, Mors O, Maier W, et al. Adverse reactions to antidepressants. Br J Psychiatry 2009;195:202-10.  Back to cited text no. 6
    
7.
Thor KB, Katofiasc MA, Danuser H, Springer J, Schaus JM. The role of 5-HT(1A) receptors in control of lower urinary tract function in cats. Brain Res 2002;946:290-7.  Back to cited text no. 7
    
8.
Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A critical review of the literature. Psychother Psychosom 2016;85:270-88.  Back to cited text no. 8
    




 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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