COMPARATIVE STUDY BETWEEN PREOPERATIVE STENTING VERSUS PREOPERATIVE TAMSULOSIN IN THE URETEROSCOPIC MANAGEMENT OF UPPER AND MIDDLE URETERAL STONES IN ADULTS

Abstract

Background: Ureteroscopy is the first-line therapy for management of upper or middle ureteral stones. Adjuvant treatments prior to ureteroscopy may reduce complications and improve success rates and stone free rates. Aim of Study: To compare and assess the efficacy, safety and outcome of preoperative ureteric stenting versus preoperative Tamsulosin use versus direct ureteroscopy in the ureteroscopic management of single upper or middle ureteral calculi in adults. Patients and Methods: This prospective, randomized, multicenter study was carried out on 60 adult patients with single upper or middle ureteral calculi less than 20mm scheduled for semi-rigid ureteroscopy and pneumatic lithotripsy at Urology department, Ain Shams University Hospitals and Dar Alshifa Hospital in Cairo between February 2019 and February 2020. Sixty patients were randomized into 3 equal groups; group A (Preoperative stenting before ureteroscopy), group B (Preoperative Tamsulosin before ureteroscopy) and group C (Direct ureteroscopy). Patient's demographics, stone characteristics, intraoperative, postoperative complications and outcome were assessed and compared. Results: Our results revealed that the mean operative time was 53.65±9.29min in group B shorter than group A 54.30±8.34min and group C 62.25±12.05min (p=0.014). Postoperative colic was 5% in group B less than group A 15% and group C 35% (p=0.044). Stone free rate after 1 month was 95% in group A more than group B 85% and group C 60% (p=0.017). Success rate was 95% in group A more than group B 90% and group C 65% (p=0.002). Ureteroscope access was 100% in group A more than group B 90% and group C 35% (p=0.006). Hospitalization time was 1.250.34days in group A shorter than group B 1.550.55days and group C 1.800.47days (p=0.002). Patients needed to do auxiliary DJ, repeat URS, ESWL or open ureterolithotomy were 0%, 0%, 5%, 0% in group A, 15%, 0%, 10%, 0% in group B and 40%, 20%, 10%, 5% in group C (p-values= 0.004, 0.014, 0.804, 0.362) respectively. Conclusion: Use of preoperative Tamsulosin or preoperative ureteral stenting before semi-rigid ureteroscopy and ureteroscopic lithotripsy using pneumatic lithotripsy in the ureteroscopic management of upper or middle ureteral stones in adults is safe and effective more than direct ureteroscopy. Preoperative tamsulosin significantly reduced operative time and decreased postoperative colic. While preoperative ureteral stenting significantly improved stone free rates, success rates, ureteroscopic access and significantly reduced hospitalization time, need for ureteral dilatation and auxiliary procedures.