Semi-Rigid Ureteroscopy for Proximal Ureteral Stones: Does Adjunctive Tamsulosin Therapy Increase the Chance of Success?

Abstract

Objectives: To assess the efficacy of adjunctive tamsulosin therapy in improving the success rate of laser-assisted semi-rigid ureteroscopy (URS) for removing proximal ureteral stones. Patients and Methods: This prospective study included 165 patients with proximal ureteral stones ≥10 mm. The patients were randomly assigned to a tamsulosin group (Group I, n = 81) receiving tamsulosin 0.4 mg daily for 1 week pre-URS and a control group (Group II, n = 84) without tamsulosin therapy. Treatment consisted of URS using a semi-rigid ureteroscope (7.5 Fr), followed by intracorporeal holmium: YAG laser lithotripsy. The patients were followed up regularly for 8 weeks after URS. Results: The operative time was 43.4 and 49.6 min in Groups I and II, respectively (p < 0.001). Scope to stone access rate was 93.8 and 82.1% in patients of Groups I and II, respectively (p = 0.022). The stone-free rate was significantly higher in Group I compared to Group II (74/81; 91.4% vs. 67/84; 79.8%; p = 0.035). The complication rate was significantly lower in Group I compared to Group II (17.3 vs. 38.1%, p = 0.003). Only minor complications were encountered and were managed conservatively. Conclusions: Tamsulosin therapy prior to semi-rigid URS improved ureteroscopic access to proximal ureteral stones, thus leading to an increased success rate and low morbidity.

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

“…This significant difference may be due to the time taken for ureteric orifice dilatation and for advancing the ureteroscope to access the stone, which was easier and faster in the Silodosin group. This result is congruent with Ahmed et al [25] , who reported that operative time was shorter in patients who received tamsulosin (an α-AR blocker). However, Aydin et al [26] did not find a significant difference in the operative time between the studied groups.…”

“…Ahmed et al [25] and Aydin et al [26] reported that access to the stone failed in 12.1% and 17% of cases, respectively. In the present study, advancing the ureteroscope to access the stones succeeded in 60/62 cases in the Silodosin group, whilst in the Placebo group success was achieved in 52/65 cases.…”

“…Ahmed et al [25] reported that the use of tamsulosin (an α-AR blocker) as adjunctive therapy prior to semi-rigid URS for the management of proximal ureteric stones increased the success rate and minimised the rate of complications. Aydin et al [26] showed that administration of silodosin before URS for managing stones located at all levels of the ureter achieved a higher access rate with lower complications.…”

Evaluation with Decision Trees of Efficacy and Safety of Semirigid Ureteroscopy in the Treatment of Proximal Ureteral Calculi

“…Yuksel et al [19] performed semirigid ureteroscopy combined with holmium: YAG laser in the treatment of proximal ureteral stones and reported a success rate of 81.1%. Similarly, Ahmed et al found that the success rates of semirigid URS followed by holmium: YAG laser lithotripsy for proximal ureteral stones ≥ 10 mm, receiving tamsulosin pre-URS and without tamsulosin therapy, were 91.4 and 79.8%, respectively ( p = 0.035) [20] . In our study, the success rate for 120 patients with stone fragmented by holmium laser was 90.8%.…”

A stone pushed back to the collecting system – long therapeutic path in centers with limited access to flexible instruments

“…In this retrospective study follow-up of 66 patients after endoscopic relocation of ureteral stone to the collecting system is presented. With mean number of 2.6 additional procedures per patient (not to mention minor procedures as stent change or removal) final SFR of 79% is a poor outcome taking into account published results of SR-URS, SWL or PNL [ 4 – 15 ].…”