Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials

Objectives This work aims to determine the efficacy and safety of preoperative alpha‐blocker therapy on ureteroscopy (URS) outcomes. Methods In this systematic review and meta‐analysis of randomised trials of URS with or without preoperative alpha‐blocker therapy, outcomes included the need for uret...

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Bibliographic Details
Published in:BJUI compass 2024-07, Vol.5 (7), p.613-620
Main Authors: Bhojani, Naeem, Chew, Ben H., Bhattacharyya, Samir, Krambeck, Amy E., Ghani, Khurshid R., Miller, Larry E.
Format: Article
Language:English
Subjects:
alpha‐blocker
Bias
Collaboration
kidney stone
Length of stay
Meta-analysis
Patients
Review
silodosin
Systematic review
tamsulosin
ureteral
ureteroscopy
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Summary:Objectives This work aims to determine the efficacy and safety of preoperative alpha‐blocker therapy on ureteroscopy (URS) outcomes. Methods In this systematic review and meta‐analysis of randomised trials of URS with or without preoperative alpha‐blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random‐effects meta‐analysis and meta‐regression. Certainty of evidence was assessed using the GRADE criteria. Results Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone‐free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha‐blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p 
ISSN:2688-4526
2688-4526
DOI:10.1002/bco2.358