Urology practice · 2025
The Effect of Preoperative Tamsulosin on Pediatric Ureteroscopic Access: A Multi-Institutional Experience.
СтатьяМногоцентровое исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Meyer Kayla M, Asantey Kwesi, Ellison Jonathan S, Jadcherla Aditya, Kostman Tori, Ostergar Adam, Traxel Erica J, Paradis Alethea, Vetter Joel, Storm Douglas W, Wendt Linder, Ten Eyck Patrick, Davis Erik S, McGee Lauren, Kraft Kate H
Аннотация
INTRODUCTION: The ability to perform flexible ureteroscopy in children may be limited because of a smaller pediatric ureterovesical junction and ureteral diameter. Tamsulosin has been shown to improve success rates of ureteral instrumentation in adults. To date, the efficacy of this medication to facilitate pediatric ureteral access remains unclear.
METHODS: We conducted a multi-institutional retrospective review of patients aged 0 to 17 years who underwent ureteroscopy for the treatment of nephrolithiasis from 2013 to 2022. Patients were excluded if they had undergone ureteroscopy or ureteral stent placement within the prior year, underwent semirigid ureteroscopy, or had a known genitourinary abnormality. Study groups included patients prescribed 0.4 mg tamsulosin daily for at least 1 week preoperatively and patients who did not receive tamsulosin.
RESULTS: There were 382 patients included, with 126 in the tamsulosin group and 256 in the no-tamsulosin group. Although there were no differences in sex, race, and stone characteristics between the 2 groups, the tamsulosin group was significantly older and had a larger BMI. One week of preoperative tamsulosin was associated with a significantly increased success of flexible ureteroscopic access on first attempt ureteroscopy, with a 24% failure in the no-tamsulosin group vs a 13% failure in the tamsulosin group (P = .010).
CONCLUSIONS: Our results expand on prior research and suggest that at least 1 week of preoperative tamsulosin facilitates flexible ureteroscopic access in the pediatric population. These results have significant clinical implications, with the potential to reduce multiple procedures and spare children from repeat anesthetic exposures.
METHODS: We conducted a multi-institutional retrospective review of patients aged 0 to 17 years who underwent ureteroscopy for the treatment of nephrolithiasis from 2013 to 2022. Patients were excluded if they had undergone ureteroscopy or ureteral stent placement within the prior year, underwent semirigid ureteroscopy, or had a known genitourinary abnormality. Study groups included patients prescribed 0.4 mg tamsulosin daily for at least 1 week preoperatively and patients who did not receive tamsulosin.
RESULTS: There were 382 patients included, with 126 in the tamsulosin group and 256 in the no-tamsulosin group. Although there were no differences in sex, race, and stone characteristics between the 2 groups, the tamsulosin group was significantly older and had a larger BMI. One week of preoperative tamsulosin was associated with a significantly increased success of flexible ureteroscopic access on first attempt ureteroscopy, with a 24% failure in the no-tamsulosin group vs a 13% failure in the tamsulosin group (P = .010).
CONCLUSIONS: Our results expand on prior research and suggest that at least 1 week of preoperative tamsulosin facilitates flexible ureteroscopic access in the pediatric population. These results have significant clinical implications, with the potential to reduce multiple procedures and spare children from repeat anesthetic exposures.