Adjuvant Therapy After Surgical Stone Management

Ferrandino, Michael N.; Monga, Manoj; Preminger, Glenn M.

doi:10.1053/j.ackd.2008.10.007

Cited by 5 publications

(3 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Variable distribution of alpha receptor subtypes were found in the proximal, middle, and distal ureter. Alpha-blockers are now commonly prescribed for ureteral colic in various hospitals 15 , 22 .…”

Section: Discussionmentioning

confidence: 99%

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

Background: Urolithiasis cases are a common condition, and the number is still growing today. The prevalence of urinary tract stones globally currently ranges from 2-20% with a recurrence rate of around 50%. The present study aims to investigate the efficacy of adjunctive alpha-blockers in improving the success rate of ureteroscopy (URS) procedure for urolithiasis. Methods: We reviewed articles obtained from MEDLINE, CENTRAL, CINAHL, and Elsevier from 14 August to 9 September 2020, comparing alpha-blockers as adjunctive therapy, versus either a placebo or no drug at all, in post-URS urolithiasis patients. There were no restrictions on the type of URS and alpha-blockers given to patients. The quality of studies included was assessed using Cochrane’s Risk of Bias Assessment for Randomized-Controlled Trials. Results: Forest plot analysis emphasizes the statistically significant difference among the group, where the adjunctive alpha-blocker group had pooled relative risk (RR) of being stone-free, readmitted due to initial URS failure, having an overall complication, having haematuria, getting their ureteral mucous injured, and suffering a colic episode was 1.71 (95% CI, 1.11–1.24), 0.50 (95% CI, 0.25–1.01), 0.41 (95% CI, 0.27–0.61), 0.42 (95% CI, 0.22–0.79), 0.31 (95% CI, 0.13–0.73), and 0.21 (95% CI, 0.06–0.69), respectively. Conclusions: Alpha blockers minimize the frequency and duration of ureteral contractions, allowing smooth stone expulsion. With this knowledge, it is expected to help clinicians decide the importance of adjunctive alpha-blocker administration.

show abstract

Section: Discussionmentioning

confidence: 99%

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Alpha-blockers are now commonly prescribed for ureteral colic in various hospitals. 15,22 This systematic review and meta-analysis have several strengths. Firstly, this systematic review and meta-analysis included a relatively broad scope of population.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background: Urolithiasis cases are a common condition, and the number is still growing today. The prevalence of urinary tract stones globally currently ranges from 2-20% with a recurrence rate of around 50%. The present study aims to investigate the efficacy of adjunctive alpha-blockers in improving the success rate of ureterorenoscopy (URS) procedure for urolithiasis. Methods: We reviewed articles obtained from MEDLINE, CENTRAL, CINAHL, and Elsevier from 14 August to 9 September 2020, comparing alpha-blockers as adjunctive therapy, versus either a placebo or no drug at all, in post-URS urolithiasis patients. There were no restrictions on the type of URS and alpha-blockers given to patients. The quality of studies included was assessed using Cochrane’s Risk of Bias Assessment for Randomized-Controlled Trials. Results: Forest plot analysis emphasizes the statistically significant difference among the group, where the adjunctive alpha-blocker group had pooled relative risk (RR) of being stone-free, readmitted due to initial URS failure, having an overall complication, having haematuria, getting their ureteral mucous injured, and suffering a colic episode was 1.71 (95% CI, 1.11–1.24), 0.50 (95% CI, 0.25–1.01), 0.41 (95% CI, 0.27–0.61), 0.42 (95% CI, 0.22–0.79), 0.31 (95% CI, 0.13–0.73), and 0.21 (95% CI, 0.06–0.69), respectively. Conclusions: Alpha blocker minimizes the frequency and duration of ureteral contractions, allowing smooth stone expulsion. With this knowledge, it is expected to help clinicians decide the importance of adjunctive alpha-blocker administration.

show abstract

“…Adjuvant therapy is a fertile area for research in the surgical management of urolithiasis, and the optimal agents have yet to be determined. It has been suggested that adjuvant therapy could increase stone‐free rates, reduce stone remission rates, prevent renal damage, and decrease postoperative morbidity 53 . Potential adjuvant agents include α‐blockers, antioxidants and alkalinizing agents.…”

Section: Epiloguementioning

confidence: 99%

Current status of ureteroscopic treatment for urolithiasis

et al. 2009

View full text Add to dashboard Cite

Intracorporeal treatment of urolithiasis is characterized by continuous technological evolution. In this review we present updated data upon the use of ureteroscopy for the management of urolithiasis. Novel digital flexible ureteroscopes are used in clinical practice. Ureteroscopic working tools are revolutionized resulting in safer and more efficient procedures. Special categories of stone patients such as pregnant women, children and patients on anticoagulation medication can now undergo uneventful ureteroscopy. Routine insertion of stents and access sheaths as well as bilateral ureteroscopy is still a controversial issue. Future perspectives include smaller and better instruments to visualize and treat a stone, while robotic ureteroscopy is becoming a fascinating reality.Key words: evolution, indications, technique, ureteroscopy. IntroductionSince its first description over 20 years ago, ureteroscopic surgery (URS) has progressed from an awkward diagnostic procedure with limited visualization to a precise, complex surgical intervention allowing access to the entire collecting system. 1 Current practice patterns in the management of upper urinary tract stones reveal that fellowshiptrained endourologists, academic urologists, and urologists in practice for less than 5 years are more likely to utilize URS and/or percutaneous nephrolithotomy (PCNL) and less likely to utilize extracorporeal shock wave lithotripsy (SWL).2 Herein, we review the relevant literature, published in Medline-indexed journals since 2008, upon the ureteroscopic treatment of urolithiasis (Table 1). Stone location Renal stonesFlexible URS is indicated in treating renal stones less than 15 mm that do not respond to SWL and is an attractive option for treating renal and ureteral stones in the same patient in a single session.3 Stone size larger than 15 mm is associated with single-session treatment failure for stone-free status. 4 In the vast majority, cases of flexible URS for unilateral renal stones can be performed as outpatient procedures. In a study of 51 patients with 161 renal stones (mean stone size of 6.6 mm), the overall stone-free rate after one and two procedures was 64.7% and 92.2%, respectively.5 In 97.6% of the cases the operation was performed on an outpatient basis.Perlmutter et al. studied whether stone location affects the stone-free rates of flexible URS. 6 A total of 86 renal stones were treated and the stone-free rates were 100% for upper pole stones, 95.8% for middle pole and 90.9% for lower pole stones (P = 0.338). Lower pole stones may not be easily accessed and fragmented because of acute infundibular angles and reduced deflection of ureteroscopes. This can be overcome by relocating lower pole stones into a more favorable location before fragmentation. A prospective randomized trial comparing SWL (32 patients) and URS (35 patients) for lower pole caliceal stones of 1 cm or less, demonstrated a statistically significant difference in stonefree rates in favor of URS.7 However, SWL was associated with greater pa...

show abstract

Adjuvant Therapy After Surgical Stone Management

Cited by 5 publications

References 41 publications

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

The efficacy of adjunctive alpha-blockers on ureteroscopy procedure for ureteral stones: a systematic review and meta-analysis

Current status of ureteroscopic treatment for urolithiasis

Contact Info

Product

Resources

About