Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China,
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.
Urol Int. 2023;107(6):557-563. doi: 10.1159/000528889. Epub 2023 Feb 22.
Urolithiasis is one of the most common diseases in the world, and at present, ureteroscopy (URS) is the first choice for its treatment. Although the effect is good, there is a risk of insertion failure of ureteroscope. Tamsulosin, as an α-receptor blocker, has the function of relaxing ureteral muscles, and can help stones to be discharged from ureteral orifice. In this study, we aimed to determine the effect of preoperative tamsulosin on ureteral navigation, operation, and safety.
This study was conducted and reported according to the meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed and Embase databases were searched for studies. Data were extracted according to the PRISMA principles. We collected and combined randomized controlled trial and researches in reviews of preoperative tamsulosin to explore the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. A data synthesis was performed using RevMan 5.4.1 software (Cochrane). Heterogeneity was mainly evaluated with I2 tests. Key metrics include: success rate of ureteral navigation, time of URS, stone-free rate, and postoperative symptoms.
We summarized and analyzed 6 studies. We noted a statistically significant improvement in the success rate of ureteral navigation (Mantel-Haenszel [M-H], odds ratio [OR]: 3.78, 95% confidence interval [CI]: [2.34, 6.12], p < 0.01) and stone-free rate (M-H, OR: 2.25, 95% CI: [1.16, 4.36], p = 0.02) with tamsulosin preoperatively. At the same time, we also observed that postoperative fever (M-H, OR: 0.37, 95% CI: [0.16, 0.89], p = 0.03) and postoperative analgesia (M-H, OR: 0.21, 95% CI: [0.05, 0.92], p = 0.04) were also reduced because of preoperative tamsulosin.
Preoperative tamsulosin can not only increase the one-time success rate of ureteral navigation and the stone-free rate of URS but also reduce the incidence of postoperative adverse symptoms such as postoperative fever and postoperative pain.
尿石症是世界上最常见的疾病之一，目前，输尿管镜检查（URS）是其治疗的首选方法。尽管效果良好，但输尿管镜插入术存在失败的风险。坦索罗辛作为一种α受体阻滞剂，具有松弛输尿管肌肉的功能，有助于结石从输尿管口排出。在这项研究中，我们旨在确定术前坦索罗辛对输尿管导航、手术和安全性的影响。
本研究按照系统评价和荟萃分析扩展的首选报告项目（PRISMA）进行并报告。检索了 PubMed 和 Embase 数据库中的研究。根据 PRISMA 原则提取数据。我们收集并结合了术前坦索罗辛的随机对照试验和综述研究，以探讨术前坦索罗辛对输尿管导航、手术和安全性的影响。使用 RevMan 5.4.1 软件（Cochrane）进行数据综合。主要用 I2 检验评估异质性。关键指标包括：输尿管导航成功率、URS 时间、结石清除率和术后症状。
我们总结和分析了 6 项研究。我们注意到，术前坦索罗辛可显著提高输尿管导航成功率（Mantel-Haenszel [M-H]，优势比 [OR]：3.78，95%置信区间 [CI]：[2.34, 6.12]，p < 0.01）和结石清除率（M-H，OR：2.25，95% CI：[1.16, 4.36]，p = 0.02）。同时，我们还观察到，由于术前坦索罗辛，术后发热（M-H，OR：0.37，95% CI：[0.16, 0.89]，p = 0.03）和术后镇痛（M-H，OR：0.21，95% CI：[0.05, 0.92]，p = 0.04）也有所减少。
术前坦索罗辛不仅可以提高输尿管一次性导航成功率和 URS 结石清除率，还可以降低术后发热和术后疼痛等不良症状的发生率。
