Effect of Preoperative Alpha-blockers on Successful Insertion Ureteral Access Sheath and Reduce Ureteral Injury in Non-prestented Patients During RIRS. Assessment of Factors for Successful Ureteral Access Sheath Insertion.

Overview

The aim of the study is to evaluate the effect of preoperative taking alpha-blockers (tamsulosin or silodosin) on the success rate of ureteral access sheath (UAS) insertion and the degree of ureteral injury during RIRS in non-prestented patients. The results showed that patients who received alpha-blockers had a higher rate of successful UAS insertion and a lower degree of ureteral injury compared to non-prestented patients. In addition, patients with a BMI greater than 25 kg/m² and those older than 59 years demonstrated a higher success rate of UAS insertion and lower degree of ureteral injury.

Study Title: Effect of Preoperative Tamsulosin and Silodosin on Successful Insertion Ureteral Access Sheath and Reduce Ureteral Injury in Non-Prestented Patients During Retrograde Intrarenal Surgery (RIRS). Assessment of factors for successful ureteral access sheath insertion. Randomized clinical trial. Study Design: Prospective, randomized, open-label, controlled trial with four parallel arms. Conducted from July 2021 to June 2024. Study Center: Department of Urology, St. Luke's Clinical Hospital, St. Petersburg, Russia Study Population: 140 patients, divided into four equal groups of 35 people each: Group I (Tamsulosin): Non-prestented patients receiving 0.4 mg of Tamsulosin daily for 7 days before RIRS. Group II (Silodosin): Non-prestented patients receiving 8 mg of Silodosin daily for 7 days before RIRS. Group III: Prestented patients. Group IV: Control group (non-prestented patients) Interventions: All patients received antibiotic prophylaxis with third-generation cephalosporins 30 minutes before surgery. RIRS was performed using disposable flexible ureteroscopes. The UAS diameter was 11/13 Fr. Thulium fiber laser was used for lithotripsy. Stone fragmentation was performed in dusting and fragmentation modes, with a total power not exceeding 20 W and a fiber thickness of 200 µm. Statistical Analysis: Data were analyzed using Shapiro-Wilk, Mann-Whitney U, Kruskal-Wallis, and chi-square tests with Bonferroni correction (SPSS v26, JMP Pro 17). Statistical significance was set at p\<0.05. Key Findings: Comparable baseline characteristics (p\>0.05) Significantly higher UAS success rates: Tamsulosin: 31 (88.57%) Silodosin: 32 (91.43%) Prestented: 33 (94.29%) Control: 62.86% (p=0.0008) Preoperative taking Silodosin significantly reduced degree ureteral injury (p=0.0253). Patients receiving alpha-blockers experienced less postoperative pain compared to the control group (p\<0.0001) and less inflammatory changes in blood tests compared to prestented patients (WBC: p=0.0002; CRP: p\<0.0001) Patients with BMI ≥ 25 kg/m² and age ≥ 59 years had a higher success rate of UAS insertion (p\<0,0001). Patients with BMI ≥ 25 kg/m² and age ≥ 59 years have a lower degree of ureteral injury (p\<0,0001). Conclusions: Preoperative taking of alpha-blockers (Tamsulosin or Silodosin) increases the success of UAS insertion. Silodosin reduces the degree ureteral injury. Patients taking alpha-blockers less postoperative pain and inflammatory changes in blood tests. A BMI ≥ 25 kg/m² and age ≥ 59 years increase the success of UAS insertion and reduce degree of ureteral injury Clinical Implications: This study provides evidence supporting the use of alpha-blockers, particularly silodosin, for passive ureteral dilation prior to RIRS in non-prestented patients, potentially reducing compications and improving patient outcomes.