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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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| Published in: | BJUI compass 2024-07, Vol.5 (7), p.613-620 |
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| creator | Bhojani, Naeem Chew, Ben H. Bhattacharyya, Samir Krambeck, Amy E. Ghani, Khurshid R. Miller, Larry E. |
| description | 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 |
| doi_str_mv | 10.1002/bco2.358 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_28ba23cfdf204c82978d7b428a5f860a</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_28ba23cfdf204c82978d7b428a5f860a</doaj_id><sourcerecordid>3082311754</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5338-9885ad966cb4727bd7dd73140a789453044633466552c3b43ee6295a64912d633</originalsourceid><addsrcrecordid>eNp1ks9u1DAQhy0EotVSiSdAkbhwSXH8LzYX1K5aqFSpFzhbjj3pZkniYDtFe-MReEaepE63lBaJ01ieT59GvxmEXlf4uMKYvG-sJ8eUy2fokAgpS8aJeP7ofYCOYtzijNKK1hS_RAdUYUIEV4doc9a2YFPh22IK4CcIJnU3UJh-2pjfP381vbffIMTCj8UcIEHw0fppV_g5WT9A_FCcFAOkhTWj6Xexi4ssmNH5oYvgihQ608dX6EWbCxzd1xX6en72Zf25vLz6dLE-uSwtp1SWSkpunBLCNqwmdeNq52paMWxqqRinmDFBKROCc2JpwyiAIIobwVRFXG6t0MXe67zZ6il0gwk77U2n7z58uNYmpM72oIlsDKG2dS3BzEqiaunqhhFpeCsFNtn1ce-a5mYAZ2FMwfRPpE87Y7fR1_5GVxVhSua4V-jdvSH47zPEpHMmFvrejODnqCmWeStVzVlG3_6Dbv0ccqR3FCM5E6X-Cm1eRAzQPkxTYb2cg17OQedzyOibx9M_gH-Wn4FyD_zoetj9V6RP11dkEd4Crtm_eg</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3084296699</pqid></control><display><type>article</type><title>Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials</title><source>Open Access: Wiley-Blackwell Open Access Journals</source><source>Publicly Available Content (ProQuest)</source><source>PubMed</source><creator>Bhojani, Naeem ; Chew, Ben H. ; Bhattacharyya, Samir ; Krambeck, Amy E. ; Ghani, Khurshid R. ; Miller, Larry E.</creator><creatorcontrib>Bhojani, Naeem ; Chew, Ben H. ; Bhattacharyya, Samir ; Krambeck, Amy E. ; Ghani, Khurshid R. ; Miller, Larry E.</creatorcontrib><description><![CDATA[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 < 0.001), procedure time (mean difference [MD] = −6 min; 95% CI = −8 to −3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = −0.3 days; 95% CI = −0.4 to −0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha‐blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods.
Conclusion
While URS is an effective and safe treatment for stone disease, preoperative alpha‐blocker therapy is well tolerated and can further improve patient outcomes.]]></description><identifier>ISSN: 2688-4526</identifier><identifier>EISSN: 2688-4526</identifier><identifier>DOI: 10.1002/bco2.358</identifier><identifier>PMID: 39022659</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>alpha‐blocker ; Bias ; Collaboration ; kidney stone ; Length of stay ; Meta-analysis ; Patients ; Review ; silodosin ; Systematic review ; tamsulosin ; ureteral ; ureteroscopy</subject><ispartof>BJUI compass, 2024-07, Vol.5 (7), p.613-620</ispartof><rights>2024 The Authors. published by John Wiley & Sons Ltd on behalf of BJU International Company.</rights><rights>2024 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.</rights><rights>2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5338-9885ad966cb4727bd7dd73140a789453044633466552c3b43ee6295a64912d633</cites><orcidid>0000-0002-5315-0710 ; 0000-0002-6089-0733 ; 0000-0003-2679-2635 ; 0000-0003-1594-1885</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249831/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249831/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,11542,27903,27904,36991,36992,46030,46454,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39022659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhojani, Naeem</creatorcontrib><creatorcontrib>Chew, Ben H.</creatorcontrib><creatorcontrib>Bhattacharyya, Samir</creatorcontrib><creatorcontrib>Krambeck, Amy E.</creatorcontrib><creatorcontrib>Ghani, Khurshid R.</creatorcontrib><creatorcontrib>Miller, Larry E.</creatorcontrib><title>Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials</title><title>BJUI compass</title><addtitle>BJUI Compass</addtitle><description><![CDATA[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 < 0.001), procedure time (mean difference [MD] = −6 min; 95% CI = −8 to −3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = −0.3 days; 95% CI = −0.4 to −0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha‐blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods.
Conclusion
While URS is an effective and safe treatment for stone disease, preoperative alpha‐blocker therapy is well tolerated and can further improve patient outcomes.]]></description><subject>alpha‐blocker</subject><subject>Bias</subject><subject>Collaboration</subject><subject>kidney stone</subject><subject>Length of stay</subject><subject>Meta-analysis</subject><subject>Patients</subject><subject>Review</subject><subject>silodosin</subject><subject>Systematic review</subject><subject>tamsulosin</subject><subject>ureteral</subject><subject>ureteroscopy</subject><issn>2688-4526</issn><issn>2688-4526</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>DOA</sourceid><recordid>eNp1ks9u1DAQhy0EotVSiSdAkbhwSXH8LzYX1K5aqFSpFzhbjj3pZkniYDtFe-MReEaepE63lBaJ01ieT59GvxmEXlf4uMKYvG-sJ8eUy2fokAgpS8aJeP7ofYCOYtzijNKK1hS_RAdUYUIEV4doc9a2YFPh22IK4CcIJnU3UJh-2pjfP381vbffIMTCj8UcIEHw0fppV_g5WT9A_FCcFAOkhTWj6Xexi4ssmNH5oYvgihQ608dX6EWbCxzd1xX6en72Zf25vLz6dLE-uSwtp1SWSkpunBLCNqwmdeNq52paMWxqqRinmDFBKROCc2JpwyiAIIobwVRFXG6t0MXe67zZ6il0gwk77U2n7z58uNYmpM72oIlsDKG2dS3BzEqiaunqhhFpeCsFNtn1ce-a5mYAZ2FMwfRPpE87Y7fR1_5GVxVhSua4V-jdvSH47zPEpHMmFvrejODnqCmWeStVzVlG3_6Dbv0ccqR3FCM5E6X-Cm1eRAzQPkxTYb2cg17OQedzyOibx9M_gH-Wn4FyD_zoetj9V6RP11dkEd4Crtm_eg</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Bhojani, Naeem</creator><creator>Chew, Ben H.</creator><creator>Bhattacharyya, Samir</creator><creator>Krambeck, Amy E.</creator><creator>Ghani, Khurshid R.</creator><creator>Miller, Larry E.</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-5315-0710</orcidid><orcidid>https://orcid.org/0000-0002-6089-0733</orcidid><orcidid>https://orcid.org/0000-0003-2679-2635</orcidid><orcidid>https://orcid.org/0000-0003-1594-1885</orcidid></search><sort><creationdate>202407</creationdate><title>Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials</title><author>Bhojani, Naeem ; Chew, Ben H. ; Bhattacharyya, Samir ; Krambeck, Amy E. ; Ghani, Khurshid R. ; Miller, Larry E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5338-9885ad966cb4727bd7dd73140a789453044633466552c3b43ee6295a64912d633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>alpha‐blocker</topic><topic>Bias</topic><topic>Collaboration</topic><topic>kidney stone</topic><topic>Length of stay</topic><topic>Meta-analysis</topic><topic>Patients</topic><topic>Review</topic><topic>silodosin</topic><topic>Systematic review</topic><topic>tamsulosin</topic><topic>ureteral</topic><topic>ureteroscopy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bhojani, Naeem</creatorcontrib><creatorcontrib>Chew, Ben H.</creatorcontrib><creatorcontrib>Bhattacharyya, Samir</creatorcontrib><creatorcontrib>Krambeck, Amy E.</creatorcontrib><creatorcontrib>Ghani, Khurshid R.</creatorcontrib><creatorcontrib>Miller, Larry E.</creatorcontrib><collection>Open Access: Wiley-Blackwell Open Access Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BJUI compass</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhojani, Naeem</au><au>Chew, Ben H.</au><au>Bhattacharyya, Samir</au><au>Krambeck, Amy E.</au><au>Ghani, Khurshid R.</au><au>Miller, Larry E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials</atitle><jtitle>BJUI compass</jtitle><addtitle>BJUI Compass</addtitle><date>2024-07</date><risdate>2024</risdate><volume>5</volume><issue>7</issue><spage>613</spage><epage>620</epage><pages>613-620</pages><issn>2688-4526</issn><eissn>2688-4526</eissn><abstract><![CDATA[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 < 0.001), procedure time (mean difference [MD] = −6 min; 95% CI = −8 to −3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = −0.3 days; 95% CI = −0.4 to −0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha‐blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods.
Conclusion
While URS is an effective and safe treatment for stone disease, preoperative alpha‐blocker therapy is well tolerated and can further improve patient outcomes.]]></abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>39022659</pmid><doi>10.1002/bco2.358</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5315-0710</orcidid><orcidid>https://orcid.org/0000-0002-6089-0733</orcidid><orcidid>https://orcid.org/0000-0003-2679-2635</orcidid><orcidid>https://orcid.org/0000-0003-1594-1885</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | BJUI compass, 2024-07, Vol.5 (7), p.613-620 |
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| source | Open Access: Wiley-Blackwell Open Access Journals; Publicly Available Content (ProQuest); PubMed |
| subjects | alpha‐blocker Bias Collaboration kidney stone Length of stay Meta-analysis Patients Review silodosin Systematic review tamsulosin ureteral ureteroscopy |
| title | Effect of preoperative alpha‐blockers on ureteroscopy outcomes: A meta‐analysis of randomised trials |
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