Reply Letter to Dr Victor DR et al. on: Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis.

Abstract

Dear Editor, We would like to congratulate Victor et al with their comprehensive review, titled "Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis". Recently, there have been a lot of interest regarding the use of α1-blockers such as Tamsulosin and Silodosin in the preoperative management of patients undergoing retrograde intrarenal surgery (RIRS) and/or ureteroscopy (URS). As mentioned by the authors, α1-blockers were linked to a decrease the number of significant ureteral injuries when using a Ureteral Access Sheath (UAS) and fewer complications during RIRS procedures. We believe that these findings are of great significance for endourologists, and even more importantly for junior or trainee urologists. We recognize that expert endourologist are skilled and might not find the same benefits when prescribing a preoperative α1-blocker, as compared to an inexperienced surgeon. The assistance given by these drugs to an inexperienced surgeon could be invaluable in allowing surgeries to be carried out safely, in an environment that's conducive to training and development of endourological skills. From our own preliminary data, we found that there is a decrease in the number of requests for senior or expert assistance by junior or trainee urologists preforming endourology surgeries, when a preoperative α1-blockers was prescribed. Additionally, the time needed to correctly position the UAS is shorter. Therefore, in our opinion, these drugs should be routinely prescribed before endourological interventions and that α1-blockers are an invaluable tool, in the same way as surgical simulators , the correct choice of candidate patients through adequate scores, and the ideal anesthesiologic setting. All these measures together, allow for a setting where junior or trainee urologists can train and still ensure optimal patient care to the patients.