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Review
. 2024 Apr 3;5(7):613-620.
doi: 10.1002/bco2.358. eCollection 2024 Jul.

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

Naeem Bhojani  1 , Ben H Chew  2 , Samir Bhattacharyya  3 , Amy E Krambeck  4 , Khurshid R Ghani  5 , Larry E Miller  6
Affiliations
Review

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

Naeem Bhojani et al. BJUI Compass. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] BJUI Compass. 2024 Dec 30;5(12):1324-1329. doi: 10.1002/bco2.482. eCollection 2024 Dec. BJUI Compass. 2024. PMID: 39744071 Free PMC article.

Abstract

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.

Keywords: alpha‐blocker; kidney stone; silodosin; tamsulosin; ureteral; ureteroscopy.

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Conflict of interest statement

Drs. Bhojani, Chew, and Krambeck report consultancy with Boston Scientific (unrelated to the current study). Dr. Bhattacharyya reports employment with Boston Scientific. Dr. Ghani reports consultancy with Boston Scientific (unrelated to the current study) and investigator funding from Olympus, Storz, Ambu, and Coloplast. Dr. Miller reports consultancy with Boston Scientific (related to the current study).

Figures

FIGURE 1
FIGURE 1
Effect of alpha‐blocker therapy before ureteroscopy on the risk of requiring ureteral dilatation. The risk ratio and 95% confidence interval are plotted for each study. The pooled risk ratio (diamond apex) and 95% confidence interval (diamond width) are calculated using a random effects model. Abbreviations: CI = confidence interval; M‐H = Mantel–Haenszel.
FIGURE 2
FIGURE 2
Effect of alpha‐blocker therapy before ureteroscopy on the risk of stone access failure. The risk ratio and 95% confidence interval are plotted for each study. The pooled risk ratio (diamond apex) and 95% confidence interval (diamond width) are calculated using a random effects model. Abbreviations: CI = confidence interval; M‐H = Mantel–Haenszel.
FIGURE 3
FIGURE 3
Effect of alpha‐blocker therapy before ureteroscopy on procedure time. Values reported in minutes. The mean difference and 95% confidence interval are plotted for each study. The pooled mean difference (diamond apex) and 95% confidence interval (diamond width) are calculated using a random effects model. Abbreviations: CI = confidence interval; IV = inverse variance; SD = standard deviation.
FIGURE 4
FIGURE 4
Effect of alpha‐blocker therapy before ureteroscopy on the risk of residual stone. (top panel) Results as reported within studies; (bottom panel) Sensitivity analysis with results adjusted for pre‐treatment stone expulsion and study withdrawals due to medication non‐compliance or adverse events. The risk ratio and 95% confidence interval are plotted for each study. The pooled risk ratio (diamond apex) and 95% confidence interval (diamond width) are calculated using a random effects model. Abbreviations: CI = confidence interval; M‐H = Mantel–Haenszel.
FIGURE 5
FIGURE 5
Effect of alpha‐blocker therapy before ureteroscopy on hospital stay. Values reported in days. The mean difference and 95% confidence interval are plotted for each study. The pooled mean difference (diamond apex) and 95% confidence interval (diamond width) are calculated using a random effects model. Abbreviations: CI = confidence interval; IV = inverse variance; SD = standard deviation.
FIGURE 6
FIGURE 6
Effect of alpha‐blocker therapy before ureteroscopy on the risk of complications (top) and serious complications (bottom). The risk ratio and 95% confidence interval are plotted for each study. The pooled risk ratio (diamond apex) and 95% confidence interval (diamond width) are calculated using a random effects model. Abbreviations: CI = confidence interval; M‐H = Mantel–Haenszel.
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