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Título

Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis

Resumo

Introduction: Ureteral access sheath use during ureteroscopy has been associated with the risk of ureteral injuries. In this scenario, preoperative administration of α1-blockers has been proposed as adjunctive therapy to mitigate the risk of injury by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. Objective: This systematic review and meta-analysis aims to examine the efficacy of α1-blockers in improving outcomes of ureteroscopy with ureteral access sheath use. Methods: A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies that compared preoperative α1-blockers administration versus its non-use in adult patients without pre-stenting undergoing ureteroscopy. Binary outcomes were evaluated using risk ratios (RR) and odds ratios (OR) with 95% confidence intervals. Heterogeneity was measured with the Cochran Q test, I2 statistics, and prediction intervals (PI). A DerSimonian and Laird random-effects model was utilized for all outcomes. Results: Eleven studies encompassing 1074 patients undergoing ureteroscopy were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17-0.53; I²=6%; PI 0.10-0.88) and an increase in mean successful ureteral access sheath insertion (OR 2.14; 95% CI 1.08-4.23; I²=23%; PI 0.51-8.93). In patients undergoing ureteroscopy lithotripsy, the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; I²=0%), and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; I²=0%). No significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; I²=91%; PI 0.47-2.59). Conclusion: Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with ureteral access sheath use and fewer complications during ureteroscopy lithotripsy procedures. However, their influence on successful ureteral access sheath insertion remains uncertain. Taken together, these findings suggest that the administration of preoperative α1-blockers should be considered.

Palavras Chave

Adrenergic α-antagonists; Ureteral access sheath; Ureteroscopy