Morley Chad, Hajiran Ali, Elbakry Amr A, Al-Qudah Hosam S, Al-Omar Osama
Department of Urology, West Virginia University, Morgantown, WV, USA.
Division of Urology, AL Zahra Hospital, Dubai, United Arab Emirates.
Res Rep Urol. 2020 Nov 16;12:563-568. doi: 10.2147/RRU.S283126. eCollection 2020.
To address whether preoperative tamsulosin increases the rate of successful ureteral orifice navigation for ureteroscopy (URS) without prestenting in school-age pediatric patients.
We retrospectively reviewed all pediatric patients who had undergone ureteroscopy (URS) at our institution from 2013 to 2020. Patients were divided into two groups: those who had received tamsulosin 0.4 mg daily ≥48 hours preoperatively and those who had not. Statistical analysis was done using independent-sample -tests and Mann-Whitney tests for continuous variables, and χ and Fisher's exact tests were used for categorical variables. Multivariate analysis was done using binary logistic regression test.
Overall, successful ureteral orifice navigation occurred in 44 of 50 patients (88%) who had received tamsulosin and 17 of 26 (65.4%) who had not (=0.019). On further subanalysis based on stone location and instrumentation used, successful ureteral orifice navigation had occurred in 21 of 24 patients (87.5%) in the tamsulosin group and one of five (20%) in the no-tamsulosin group for semirigid ureteroscopy for mid-distal ureterolithiasis (=0.007). For proximal ureteral and renal stones, successful ureteral orifice navigation with a flexible ureteroscope or ureteral access sheath had occurred in 23 of 26 patients (88.5%) in the tamsulosin group and 16 of 21 (76.2%) in the no-tamsulosin group (=0.437). Multivariate analysis showed no significant difference between success rates in the two groups after controlling for patient weight, height, BMI, and stone location. We did not observe any adverse effects from tamsulosin.
This is the first study to evaluate preoperative tamsulosin on successful ureteral orifice navigation in school-age pediatric patients. Although not reaching statistical significance, further evaluation should be done on larger cohorts. Patient height was found to be an independent predictor of successful ureteral orifice navigation.
探讨术前服用坦索罗辛是否能提高学龄期儿科患者输尿管镜检查（URS）时成功找到输尿管口的概率，且无需预先放置支架。
我们回顾性分析了2013年至2020年在我院接受输尿管镜检查（URS）的所有儿科患者。患者分为两组：术前至少48小时每日服用0.4毫克坦索罗辛的患者和未服用的患者。连续变量采用独立样本t检验和曼-惠特尼检验进行统计分析，分类变量采用χ²检验和费舍尔精确检验。多变量分析采用二元逻辑回归检验。
总体而言，服用坦索罗辛的50例患者中有44例（88%）成功找到输尿管口，未服用的26例患者中有17例（65.4%）成功找到输尿管口（P=0.019）。根据结石位置和使用的器械进一步亚组分析，对于中远端输尿管结石的半硬性输尿管镜检查，服用坦索罗辛组的24例患者中有21例（87.5%）成功找到输尿管口，未服用坦索罗辛组的5例患者中有1例（20%）成功找到输尿管口（P=0.007）。对于近端输尿管和肾结石，服用坦索罗辛组的26例患者中有23例（88.5%）使用软性输尿管镜或输尿管通路鞘成功找到输尿管口，未服用坦索罗辛组的21例患者中有16例（76.2%）成功找到输尿管口（P=0.437）。多变量分析显示，在控制患者体重、身高、BMI和结石位置后，两组成功率无显著差异。我们未观察到坦索罗辛的任何不良反应。
这是第一项评估术前坦索罗辛对学龄期儿科患者输尿管口导航成功率影响的研究。尽管未达到统计学意义，但应在更大队列中进行进一步评估。发现患者身高是输尿管口导航成功的独立预测因素。
