Semi-rigid Ureteroscopy and Holmium laser stone dusting for Proximal Ureteral Stones Does Adjuvant Tamsulosin Therapy Increase the Chance of Success?

Abstract

Abstract Background Alpha blockers decrease peristalsis above and below the stone, which increases the urine bolus and intraureteral pressure above it and lowers intraureteral pressure below it in association with the decrease in basal and micturition pressure, even at the bladder neck; thus, it increases the chance of stone expulsion.We aim to evaluate whether peri-operative tamsulosin in stented ureteroscopic laser lithotripsy for proximal ureteric stones increase the procedure success rate of stone clearance. Since our aim in ureteroscopic treatment of upper ureteric stones is laser dusting rather than stone retrieval, its possible that alpha blockers can improve the access to upper ureter and clearance of fragmented stones. Objective To evaluate whether peri-operative tamsulosin in stented ureteroscopic laser lithotripsy for proximal ureteric stones increase the procedure success rate of stone clearance. Patients and Methods This prospective, randomized, multicenter study included 60 patients and carried out between March 2018 and December 2018 in Police hospital Nasr City and Ain Shams University Hospitals included adult patients (at least 15 years) with proximal ureteral stones (≥ 5mm) scheduled for URS lithotripsy. Results In this study, the overall failure rate was 18.3%. In most cases 8/11(72.7%), failure of the procedure was due to the difficulty experienced in advancing the ureteroscope. We should mention that this technical problem was reported only in 2 (6.7%) patients receiving pre-URS tamsulosin but in 6 (20%) patients of the control group. The mean operative time in this series was significantly shorter operative time in Group 2(51.8min) compared to Group 1(58.8 min).At follow-up 4 weeks after URS, SFR was (86.7% for Group 2 and 66.7% for Group 1). Conclusion Adjunctive tamsulosin therapy prior to laser-assisted semi-rigid URS for the management of proximal ureteral stones improves ureteroscopic access, reduces the operative time and improves the SFR with an acceptable complication rate. Further research should be conducted on a larger scale to evaluate the various predictors of the outcome of URS and analyze the results with different pre-URS tamsulosin time periods in order to consolidate the results and to confirm the conclusion.