LAUSR

INTRODUCTION Preoperative alpha-blockers have been proposed to improve intraoperative outcomes and patient stone-free status following ureteroscopy for ureteric stones. MATERIALS AND METHODS We searched 6 databases including Medline, Embase, and Web of Science for randomized controlled trials evaluating alpha-blocker use prior to planned ureteroscopy for the management of ureteric calculi. Meta-analysis was performed using DerSimonian and Laird method with inverse-variance weighting. Quality of evidence was summarized using the GRADE framework. RESULTS Of 3338 records, 26 were screened as full-text and 12 randomized controlled trials were included totaling 1352 patients. Meta-analysis demonstrated a 61% reduction in need for intraoperative ureteral dilatation in patients administered preoperative alpha-blockers (relative risk [RR]: 0.39 [95% CI: 0.31 to 0.48], p<0.00001), as well as increased stone-free status for patients at 4 weeks post-operatively (RR: 1.17 [95% CI: 1.08 to 1.26], p<0.00001) and at final follow-up (RR: 1.18 [95% CI: 1.11 to 1.24], p<0.00001; median final follow-up 4 weeks [range: 2 to 8 weeks]). Urologists were more likely to reach the stone with the ureteroscope in patients administered alpha-blockers (RR: 1.16 [95% CI: 1.10 to 1.23], p<0.00001). A statistically significant reduction in operative time (MD: -6.05 [95% CI: -10.17 to -1.93] minutes, p=0.004) and length of hospital stay (weighted mean difference [MD]: -0.34 [95% CI: -0.55 to -0.13] days, p=0.001) was also demonstrated. Main reported side effects of treatments were abnormal ejaculation, postural hypotension, and dizziness. Outcomes were robust to sensitivity analyses. Results were rated moderate quality evidence using the GRADE framework. CONCLUSIONS Among patients scheduled for semi-rigid ureteroscopy of ureteric stones, use of preoperative alpha-blockers demonstrated a significant reduction in the need for ureteric orifice dilation, increase in patient stone-free status at follow-up, and facilitates higher rate of ureteroscopic access to stones while reducing operative time.