Introduction: Urologists routinely place ureteral access sheaths (UAS) prior to ureteroscopy and laser lithotripsy to expedite basket extraction and improve drainage. Alpha-blockers have been shown to relax ureteral wall smooth muscle. A prior study has suggested that pre-operative tamsulosin improves placement success of larger 16 French access sheaths. This study aims to determine if pre-operative alpha-blockers facilitate standard 12/14 French UAS placement prior to retrograde ureteroscopy.
Methods: A retrospective analysis of 527 patients from a single institution from January 2016 to December 2018 who underwent ureteroscopy and laser lithotripsy for renal and/or ureteral stones were analyzed. Demographic data, presence of pre-operative stents, UAS usage (12/14 French), UAS placement failure, need for ureteral dilation, pre-operative alpha blocker usage and duration, and unplanned ED or clinic visits within 30 days post-operatively were recorded. Chi square analysis was performed to determine the correlation between alpha-blocker use and success of UAS placement. Patients who had uncomplicated UAS placement were compared to those requiring ureteral dilation and those failing UAS placement.
Results: Of the 527 patients reviewed, an access sheath was placed in 424 patients. Of the successful UAS placement group, 219 patients (51.7%) were on pre-operative alpha-blockers and 205 patients (48.3%) were not. Nine of 424 UAS patients (2.1%) required ureteral dilation (via balloon dilator, sequential dilation, or second wire “rail-roading”) to allow the UAS to be placed (none pre-stented). Seven of these nine patients (77.8%) did not take pre-operative alpha-blockers (p=0.074). UAS placement was attempted, but not successful in eight patients (1.5%) of the total 527 patients (none pre-stented). Six out of eight (75%) of the failed UAS patients did not take any pre-operative alpha-blockers (p=0.135).
Conclusions: Approximately half of the patients who had successful UAS placement were on alpha-blockers pre-operatively, and half were not. In the groups who failed UAS placement or required dilation prior to UAS placement, there was a slightly higher proportion of patients not on pre-operative alpha-blockers, but no statistical significance was determined. Overall, pre-operative alpha-blockers were not shown to affect standard UAS placement. Investigation of a larger cohort of complicated or failed UAS placements and further prospective studies are needed to confirm these findings. Source of