Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis

• Published in: Journal of endourology Vol. 38; no. 9; p. 936
• Main Authors: Victor, David Romeiro, Oliveira, Rafael de Albuquerque Pereira de, Melão, Bárbara Vieira Lima Aguiar, Coelho, Henrique Guimarães Barbosa, Barros Júnior, Thomé Décio Pinheiro
• Format: Journal Article
• Language: English
• Published: United States 01.09.2024
• Subjects: Adrenergic alpha-1 Receptor Antagonists - therapeutic use; Humans; Preoperative Care; Treatment Outcome; Ureter - injuries; Ureter - surgery; Ureteroscopy - adverse effects; Ureteroscopy - methods; urolithiasis; adrenergic α-antagonists; ureteral access sheath; tamsulosin; ureteroscopy; silodosin
• ISSN: 1557-900X
• DOI: 10.1089/end.2024.0060

The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. Eleven studies encompassing 1074 patients undergoing URS were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17-0.53; = 6%; PI 0.10-0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08-4.23; = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; = 0%) and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; = 91%; PI 0.47-2.59). Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.