Do Preoperative Alpha Blockers Facilitate Ureteroscope Insertion at the Vesico-Ureteric Junction? An Answer from a Prospective Case-Controlled Study

*Ashok Kumar Sokhal, Kawaljit Singh, Sunny Goel, Manoj Kumar, Bimalesh Purkait, Durgesh Kumar Sain, Ashok Kumar Gupta, Satyanarayan Sankhwar

Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, India
*Correspondence to drashokkumarsokhal@gmail.com

Disclosure: The authors have declared no conflicts of interest.
Acknowledgements: The authors acknowledge the co-operation of residents of the Urology Department of King George’s Medical University who participated in data collection and evaluation of the patients. They also appreciate the commitment and compliance of the patients who reported the required data. Ethical approval: Ethical approval has been taken from The Institutional Ethical Committee. Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Received: 01.02.17 Accepted: 23.05.17
Citation: EMJ. 2017;2[3]:82-86.

Abstract

Objective: To evaluate whether alpha blockers facilitate the navigation of the ureteroscope through the ureteric orifice, if administered preoperatively, based on the role of alpha blockers, mainly tamsulosin, in medical expulsive therapy of ureteric calculus.

Methods: A prospective, case-control study of 174 patients who underwent ureteroscopic stone removal for lower or mid ureteral calculi between November 2014 and March 2016 was carried out. We included patients >14 years of age who were planned for ureteroscopic stone removal. We divided the patients into two groups, including those who were not prescribed alpha blockers prior to surgery (Group A: no alpha blocker) and those patients who were started on alpha blockers, tamsulosin 0.4 mg, 3 days prior to surgery (Group B: alpha blocker). We excluded patients with stone size >1 cm, spontaneous stone passage prior to surgery, unable to perform ureteroscopy (URS), and previous history of ureteroscopic intervention.

Results: Our study included 124 patients, among whom 60 patients were prescribed alpha blockers preoperatively (Group B). The mean age of the study population was 37.62+9.74 (15–64 years) and the mean stone burden was 38.92+8.21 (15.94–58.12 mm2). The difference in rate of ureteroscope negotiation through the ureteric orifice between Groups A and B was not statistically significant (p=0.57).

Conclusions: In URS, preoperative administration of alpha blockers failed to improve technical ease and lower complication rate. Further large group, multi-centre studies are required todiscover a definitive role of alpha blockers prior to URS.

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