Effect of Bazhengsan on the Prevention and Treatment of Postoperative Urinary Retention: A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Objectives: This study systematically reviewed randomized controlled trials (RCTs) evaluating the efficacy of Bazhengsan (BZS) for preventing and treating postoperative urinary retention (POUR).Methods: A PRISMA-guided review was conducted on RCTs investigating oral Bazhengsan (original or modified) for adults. The databases search included PubMed, CNKI, Wanfang, and RISS/KISS/OASIS. Primary outcomes were POUR incidence and time to first spontaneous void. Risk of bias was assessed using RoB 2 and evidence certainty with GRADE. Where ≥2 comparable studies were available, random-effects meta-analyses were performed.Results: Six trials assessing POUR incidence and five trials assessing time to first void were included. Bazhengsan significantly reduced POUR incidence compared to controls (OR=0.18; 95% CI: 0.13-0.25; p < 0.00001; I²=0%) and shortened time to first void (MD=-111.34 min; 95% CI: -168.91 to -53.77; p=0.006; I²=95%). Subgroup analyses by control and formulation showed no significant interactions.Conclusions: Bazhengsan may prevent POUR and expedite first urination; however, evidence certainty is low. Well-designed, multicenter RCTs are required to confirm efficacy and inform clinical guidelines.