Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the management of large distal ureteric stones: blinded randomised trial

Mohey, Ahmed; Gharib, Tarek; Alazaby, Hisham; Khalil, Maria; Abou-Taleb, Ahmed; Noureldin, Yasser A.

doi:10.1016/j.aju.2018.07.002

Cited by 11 publications

(42 citation statements)

References 28 publications

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“…They found a statistically significant decrease in the need for ureteric dilatation during URS and operative time. These results were confirmed in another study by Mohey et al in 2018 [ 8 , 16 , 17 ].…”

Section: Discussionsupporting

confidence: 80%

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Effect of perioperative selective alpha-1 blockers in non-stented ureteroscopic laser lithotripsy for ureteric stones: a randomized controlled trial

Tawfeek

Abdel‐Wahab²,

Higazy

et al. 2020

Cent european J Urol

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Introduction The aim of this studywas to assess the efficacy of perioperative alpha-1 blockers on improving the success rate and decreasing complications of non-stented ureteroscopic laser lithotripsy for ureteric stones. Material and methods A randomized control trial was conducted at two high volume urological centers from September 2017 to December 2018. We enrolled 150 patients with lower ureteric stones. They were randomly divided into two groups. Patients in group A, underwent non-stented ureteroscopy using Ho-YAG laser for stone disintegration and received alpha-1 blockers for one week preoperatively and another two weeks postoperatively. Patients in group B, underwent non-stented ureteroscopy and laser and received a placebo. Results One hundred and twenty patients were available for analysis at the end of our study. There was no statistically significant difference found between both groups regarding demographic data and stone parameters. The need for intraoperative ureteric dilatation was 32.7% and 51.6% for both groups A and B respectively with a statistically significant difference. The incidence of lower urinary tract symptoms (LUTS) and the need for analgesics were higher in group B with a statistically significant difference. Conclusions Administration of perioperative tamsulosin seems to not only to significantly decrease the need for intra-operative dilatation and hence operative time, but also leads to a significant decrease in the development of postoperative LUTs, postoperative pain and the need for analgesia and hospital stay.

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Section: Discussionsupporting

confidence: 80%

“…On the other hand, in 2017, Sokhal et al reported that there was not a statistically significant decrease in the need for ureteric dilatation during URS when using pre-URS tamsulosin. This may be attributed to the short-term use of pre-operative tamsulosin – for 3 days only [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative selective alpha-1 blockers in non-stented ureteroscopic laser lithotripsy for ureteric stones: a randomized controlled trial

Tawfeek

Abdel‐Wahab²,

Higazy

et al. 2020

Cent european J Urol

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“…Based on the inclusion and exclusion criteria, five RCTs involving 557 patients (274 in the alpha-blockers group and 283 in the placebo group) were included in the analysis. [13][14][15][16][17] The characteristics of the individual studies are presented in Table 1. All five studies included in the meta-analysis were RCTs.…”

Section: Resultsmentioning

confidence: 99%

“…All five studies (n ¼ 557; 274 in the alphablockers group and 283 in the placebo group) were used in the analysis of operation time. [13][14][15][16][17] Heterogeneity was found among the trials (I 2 ¼ 82%; P ¼ 0.0002), so a random-effects model was chosen for the analysis. There was no significant difference in operation time between the adjunctive alpha-blockers and placebo groups (MD: -3.33; 95% CI -7.03, 0.37; P ¼ 0.08) (Figure 5).…”

Section: Resultsmentioning

confidence: 99%

“…13 Subsequent publications demonstrated that alphablockers (tamsulosin and silodosin) increased access to stones and contributed to stone-free rates. [13][14][15][16][17] To date, there has not been a systematic meta-analysis to assess the efficacy and safety of adjunctive alpha-blockers versus placebo before ureteroscopy in the treatment of ureteral stones. Therefore, this current metaanalysis evaluated the effects of adjunctive alpha-blocker therapy prior to ureteroscopy in patients with ureteral stones.…”

Section: Introductionmentioning

confidence: 99%

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Pooled analysis of the efficacy and safety of adjunctive alpha-blocker therapy before ureteroscopy in the management of ureteral stones

Tan

Zhang

et al. 2020

J Int Med Res

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Objective To evaluate the efficacy and safety of adjunctive alpha-blocker therapy before ureteroscopy in the management of ureteral stones. Methods The databases MEDLINE®, EMBASE and The Cochrane Controlled Trail Register of Controlled Trials were searched between January 1980 and June 2019 to identify randomized controlled trials (RCTs) that referred to the use of alpha-blockers as adjunctive therapy before ureteroscopy for the treatment of ureteral stones. Odds ratios (ORs) with 95% confidence intervals (CIs) were used for dichotomous outcomes; and mean difference (MD) with 95% CIs were used to report continuous outcomes. Results The analysis included five RCTs with a total of 557 patients. Compared with placebo, patients that received adjunctive alpha-blockers had significantly higher successful access to the stone (OR 5.44; 95% CI 2.99, 9.88), a significantly higher stone-free rate at the end of week 4 (OR 3.75; 95% CI 2.20, 6.39), significantly less requirement for balloon dilatation (OR 0.26; 95% CI 0.15, 0.44) and a significantly lower risk of complications (OR 0.25; 95% CI 0.15, 0.42). There was no significant difference in the operation time between the two groups (MD –3.33; 95% CI –7.03, 0.37). Conclusions Adjunctive alpha-blocker therapy administered before ureteroscopy was effective in the management of ureteral stones with a lower risk of complications than placebo treatment.

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Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials

Bhojani,

Chew,

Bhattacharyya

et al. 2024

BJUI Compass

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ObjectivesThis work aims to determine the efficacy and safety of preoperative alpha‐blocker therapy on ureteroscopy (URS) outcomes.MethodsIn this systematic review and meta‐analysis of randomised trials of URS with or without preoperative alpha‐blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random‐effects meta‐analysis and meta‐regression. Certainty of evidence was assessed using the GRADE criteria.ResultsAmong 15 randomised trials with 1653 patients, URS was effective and safe with a stone‐free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha‐blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = −6 min; 95% CI = −8 to −3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = −0.3 days; 95% CI = −0.4 to −0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha‐blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods.ConclusionWhile URS is an effective and safe treatment for stone disease, preoperative alpha‐blocker therapy is well tolerated and can further improve patient outcomes.

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Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the management of large distal ureteric stones: blinded randomised trial

Cited by 11 publications

References 28 publications

Effect of perioperative selective alpha-1 blockers in non-stented ureteroscopic laser lithotripsy for ureteric stones: a randomized controlled trial

Effect of perioperative selective alpha-1 blockers in non-stented ureteroscopic laser lithotripsy for ureteric stones: a randomized controlled trial

Pooled analysis of the efficacy and safety of adjunctive alpha-blocker therapy before ureteroscopy in the management of ureteral stones

Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials

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