The Effect of Preoperative Tamsulosin on Pediatric Ureteroscopic Access: A Multi-Institutional Experience.

Abstract

Introduction: The ability to perform flexible ureteroscopy in children may be limited due to 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 0-17 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 semi-rigid ureteroscopy, or had a known genitourinary abnormality. Study groups included patients prescribed 0.4 mg tamsulosin daily for at least one 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 gender, race, and stone characteristics between the two 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 versus a 13% failure in the tamsulosin group (p=0.010).

Conclusions: Our results expand on prior research and suggest that at least one 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.