Tamsulosin Dose Escalation or Silodosin Switch Before Trial Without Catheter in BPH-Related Acute Urinary Retention

Inclusion Criteria: * Male patients aged 50 years or older. * Acute urinary retention requiring urethral catheterization. * Presumed acute urinary retention secondary to benign prostatic enlargement or benign prostatic obstruction. * Already receiving tamsulosin 0.4 mg once daily for at least 4 weeks before the acute urinary retention episode. * Successful urethral catheterization at presentation. * Initial catheterized urine volume ≤1000 mL, with a clinical presentation consistent with painful acute urinary retention. * Prostate enlargement on ultrasound or clinical assessment consistent with benign prostatic hyperplasia or benign prostatic obstruction. * Ability to provide written informed consent. Exclusion Criteria: * Known or suspected prostate cancer. * Previous prostate surgery. * Previous urethral stricture disease or urethral surgery. * Neurogenic bladder or known neurological disease affecting voiding. * Chronic urinary retention rather than acute painful retention. * Acute urinary retention due to non-BPH causes, including clot retention, bladder stone obstruction, acute prostatitis, urethral trauma, or drug-induced retention. * Severe urinary tract infection, sepsis, or fever at presentation. * Gross hematuria requiring irrigation. * Failed urethral catheterization or need for suprapubic catheterization. * Current use of silodosin, alfuzosin, doxazosin, terazosin, tadalafil, anticholinergics, beta-3 agonists, or other drugs that may significantly affect voiding…