Presented by: George Tawfellos BA
ALBANY MEDICAL COLLEGE

Introduction

α-1A-specific antagonists may facilitate the use of larger ureteral access sheaths by inducing selective ureteral smooth muscle relaxation. This can contribute to improved stone clearance and drainage in flexible ureteroscopy. We sought the effect of pre-operative α-1A- antagonists on stone free rates, intra and post-operative outcomes for elective ureteroscopy in the treatment of kidney stones larger than 10mm.

Materials

A single center retrospective analysis was conducted for 147 patients who underwent elective ureteroscopy with holmium laser lithotripsy between September 2019 and January 2023 for kidney stones larger than 10mm. The patients were divided into two groups, a study group who were on alpha-1 blockers (tamsulosin 0.4mg) for at least one week prior to surgery and control group who received no preoperative alpha-1 blockers. All patients had preoperative CT images. The mean stone burden was 17.4mm. We excluded patients that were pre-stented, with ureteral stones and with kidney stones smaller than 10mm. We recorded intraoperative sheath size, operative time, residual stones greater than 3 mm on imaging within 90 days post-surgery, re-operation rates, unplanned ED or clinic visits and hospital re-admissions within 30 days.

Results

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Among the 147 patients included, around half of the patients were within the study group (N=70, 47.6%). Our study and control groups had similar stone burden (16.8 mm vs. 19 mm p= 0.07) and similar median stone hardness (738 vs 834 Hounsfield units, p= 0.08). A larger sheath was used significantly more often in the study group (54.3%) compared to the control group (p= 0.022). The rate of stone visualization on post-operative imaging within 90 days was less in the study group (39% vs. 60%; p=0.034). There was a smaller median residual stone size in the study group (p=0.002), and a less re-operative rate (2% vs. 22.3%; p=0.0004). There was no significant difference in mean OR time (78.3 vs. 73.7 minutes, p=0.44), length of hospital stay (0.995 vs. 0.422, p=0.626), or rate of hospital readmission (2.9% vs. 7.9%, p=0.28).

Conclusion

Using pre-operative alpha-1 selective antagonists showed significant promise in intraoperative and postoperative success. Its pre-operative use is encouraged for elective ureteroscopic management of large kidney stones.

Funding

N/A

Co-Authors

Priscilla Rogriguez, BA
Albany Medical College

Maithili Gopalakrishnan, MD
Albany Medical Center

Alice Cheung, MD
Albany Medical Center

Mark White, MD
Albany Medical Center

Luay Alshara, MD
Albany Medical Center