Preoperative Alpha-Blockers for Ureteroscopy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alsaikhan, Bader; Koziarz, Alex; Lee, Jason Y.; Pace, Kenneth T.

doi:10.1089/end.2019.0520

Cited by 27 publications

(21 citation statements)

References 26 publications

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“…The study with the highest weight is by Ahmed et al 2017, 2 with a weight of 72.2%, followed by a study by Bayar et al 2019, 8 with a weight of 27.8%. This result is similar to a study done by Alsaikhan et al in 2020, 14 albeit using different parameters. They did a systematic review and meta-analysis about preoperative alpha-blockers usage for ureteroscopy for ureteric stones with parameters including risk reduction in need for intraoperative ureteral dilatation, stone-free status at four weeks post-operatively, and at final follow-up, the likeliness of urologists to reach the stone with the ureteroscope, operative time, and length of hospital stay.…”

Section: Discussionsupporting

confidence: 92%

“…It is important to note that some studies that were assessed by this study and Alsaikhan et al 2020 are different. 14 Tamsulosin, an alpha-1A blocker, has been shown to improve the stone expulsion rate and minimize the probability of colic episodes in patients during watchful waiting. 15,16 It relaxes the muscle of the ureteral wall, aiding gravel clearance after URS or ESWL procedure.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

et al. 2021

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Background: Urolithiasis cases are a common condition, and the number is still growing today. The prevalence of urinary tract stones globally currently ranges from 2-20% with a recurrence rate of around 50%. The present study aims to investigate the efficacy of adjunctive alpha-blockers in improving the success rate of ureterorenoscopy (URS) procedure for urolithiasis. Methods: We reviewed articles obtained from MEDLINE, CENTRAL, CINAHL, and Elsevier from 14 August to 9 September 2020, comparing alpha-blockers as adjunctive therapy, versus either a placebo or no drug at all, in post-URS urolithiasis patients. There were no restrictions on the type of URS and alpha-blockers given to patients. The quality of studies included was assessed using Cochrane’s Risk of Bias Assessment for Randomized-Controlled Trials. Results: Forest plot analysis emphasizes the statistically significant difference among the group, where the adjunctive alpha-blocker group had pooled relative risk (RR) of being stone-free, readmitted due to initial URS failure, having an overall complication, having haematuria, getting their ureteral mucous injured, and suffering a colic episode was 1.71 (95% CI, 1.11–1.24), 0.50 (95% CI, 0.25–1.01), 0.41 (95% CI, 0.27–0.61), 0.42 (95% CI, 0.22–0.79), 0.31 (95% CI, 0.13–0.73), and 0.21 (95% CI, 0.06–0.69), respectively. Conclusions: Alpha blocker minimizes the frequency and duration of ureteral contractions, allowing smooth stone expulsion. With this knowledge, it is expected to help clinicians decide the importance of adjunctive alpha-blocker administration.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

et al. 2021

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“…In a recent study, 1 week of pre-operative alpha-blocker therapy was associated with lower overall complications after URS [ 19 ]. The same mechanism by which alpha-blockers are prescribed to facilitate ureteral stone passage—inhibition of the alpha receptors in the distal ureter and reduced ureteral muscle tone and peristalsis—has been proposed to facilitate ureteroscopy and instrumentation of the ureter [ 20 ]. This is an area of interest that will be the subject of future investigation.…”

Section: Discussionmentioning

confidence: 99%

Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative

et al. 2020

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Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is associated with patient morbidity and increased healthcare costs. To this effect, AUA guidelines recommend at least a urinalysis in patients prior to URS. We examined risk factors for infection-related hospitalization following URS for urinary stones in a surgical collaborative. Methods Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement (QI) initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) consisting of academic and community practices in the State of Michigan. Trained abstractors prospectively record standardized data elements from the health record in a web-based registry including patient characteristics, surgical details and complications. Using the ROCKS registry, we identified all patients undergoing primary URS for urinary stones between June 2016 and October 2017, and determined the proportion hospitalized within 30 days with an infection-related complication. These patients underwent chart review to obtain clinical data related to the hospitalization. Multivariable logistic regression analysis was performed to determine risk factors for hospitalization. Results 1817 URS procedures from 11 practices were analyzed. 43 (2.4%) patients were hospitalized with an infection-related complication, and the mortality rate was 0.2%. Median time to admission and length of stay was 4 and 3 days, respectively. Nine (20.9%) patients did not have a pre-procedure urinalysis or urine culture, which was not different in the non-hospitalized cohort (20.5%). In hospitalized patients, pathogens included gram-negative (61.5%), gram-positive (19.2%), yeast (15.4%), and mixed (3.8%) organisms. Significant factors associated with infection-related hospitalization included higher Charlson comorbidity index, history of recurrent UTI, stone size, intra-operative complication, and procedures where fragments were left in-situ. Conclusions One in 40 patients are hospitalized with an infection-related complication following URS. Awareness of risk factors may allow for individualized counselling and management to reduce these events. Approximately 20% of patients did not have a pre-operative urine analysis or culture, and these findings demonstrate the need for further study to improve urine testing and compliance

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“…Two patients later developed ureteral stricture [28]. In addition to the beneficial role of alphablockers use to facilitate ureteral dilation and stone access during ureteroscopy [29,30]. The use of NSAIDS and/or chymotrypsin as add-on therapy in severely impacted stones before definitive intervention has also been suggested.…”

Section: Discussionmentioning

confidence: 99%

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Elbaset¹,

Edwan²,

Abouelkheir³

et al. 2021

Société Internationale D’Urologie Journal

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Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, < 0.001, and < 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.

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Preoperative Alpha-Blockers for Ureteroscopy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 27 publications

References 26 publications

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

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