Can alpha blockers facilitate the placement of ureteral access sheaths in retrograde intrarenal surgery?

Erturhan, Sakıp; Bayrak, Ömer; Şen, Haluk; Yılmaz, Ali Erdem; Şeçkiner, İlker

doi:10.5152/tud.2019.63373

Cited by 13 publications

(10 citation statements)

References 16 publications

(22 reference statements)

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“…Further, 49 were excluded according to the title or abstract by automation tools and manual screening. Finally, nine studies with 867 patients were included in the meta-analysis ( 12 , 13 , 15 , 21 – 26 ). Specifically, six studies were RCTs, and three were retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

Are adrenergic α1- antagonists beneficial for the access of retrograde ureteral access sheath or semi-rigid ureteroscope access? A systematic review and meta-analysis

Chi²,

Shen³

et al. 2023

Front. Surg.

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IntroductionTo evaluate the clinical benefit of preoperative adrenergic α1-antagonist therapy in the management of upper urinary calculi.Materials and methodsPublications were searched for The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE until 1 March 2022 that related to the adrenergic α1- antagonist intake as adjunctive therapy before retrograde surgery. Dichotomous data were reported with risk ratios (RR) with 95% confidence intervals (CIs) and the continuous data were reported with mean difference (MD) with 95% CIsResultsThere were nine studies with 867 patients included in this meta-analysis. Preoperative adrenergic α1- antagonists could significantly elevate the compared with the placebo. Higher successful access rate to the stone was found in patients who received preoperative adrenergic α1- antagonists than those who received the placebo (RR 1.24; 95% CI 1.17–1.33). Besides, the application of preoperative adrenergic α1- antagonists can also elevate 4th-week stone-free rate (RR 1.20; 95% CI 1.12–1.28), decrease postoperative analgesia (RR 0.30;95% CI 0.20–0.46) and result in a lower risk of overall complications (RR 0.38; 95% CI 0.24–0.61).ConclusionPreoperative adjunctive adrenergic α1- antagonist therapy is effective and safe in the management of retrograde surgery with a higher successful access rate and lower risk of severe complications.

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Section: Resultsmentioning

confidence: 99%

Are adrenergic α1- antagonists beneficial for the access of retrograde ureteral access sheath or semi-rigid ureteroscope access? A systematic review and meta-analysis

Chi²,

Shen³

et al. 2023

Front. Surg.

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“…In a retrospective study on ureteral access in 76 non-prestented school-age children, tamsulosin did not facilitate successful ureteral orifice navigation after multivariate analysis [ 58 ]. In another retrospective study, 14 days of tamsulosin prior to RIRS did not improve the UAS placement rates [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.

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“…e reason for the differences between the groups was unknown. Some drugs such as alpha-blockers and antiinflammation therapy before surgery might be beneficial in facilitating UAS placement [11,15]. Due to the lack of detailed data, medical therapy history and the duration before the RIRS were not evaluated in this research.…”

Section: Discussionmentioning

confidence: 99%

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Liu

et al. 2022

International Journal of Clinical Practice

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Purpose. Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. Methods. We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. Results. Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p = 0.013 ), length of history 15–31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p = 0.045 ), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p = 0.023 ), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p = 0.035 ) were associated with UAS placement. Conclusion. Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.

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Can alpha blockers facilitate the placement of ureteral access sheaths in retrograde intrarenal surgery?

Cited by 13 publications

References 16 publications

Are adrenergic α1- antagonists beneficial for the access of retrograde ureteral access sheath or semi-rigid ureteroscope access? A systematic review and meta-analysis

Are adrenergic α1- antagonists beneficial for the access of retrograde ureteral access sheath or semi-rigid ureteroscope access? A systematic review and meta-analysis

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

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