David Romeiro Victor, Rafael de Albuquerque Pereira de Oliveira, Bárbara Vieira Lima Aguiar Melão, Henrique Guimarães Barbosa Coelho, Thomé Décio Pinheiro Barros Júnior
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Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, <i>I</i><sup>2</sup> statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. <b><i>Results:</i></b> Eleven studies encompassing 1074 patients undergoing URS 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; <i>I</i><sup>2</sup> = 6%; PI 0.10-0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08-4.23; <i>I</i><sup>2</sup> = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; <i>I</i><sup>2</sup> = 0%) and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; <i>I</i><sup>2</sup> = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; <i>I</i><sup>2</sup> = 91%; PI 0.47-2.59). <b><i>Conclusion:</i></b> Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis.\",\"authors\":\"David Romeiro Victor, Rafael de Albuquerque Pereira de Oliveira, Bárbara Vieira Lima Aguiar Melão, Henrique Guimarães Barbosa Coelho, Thomé Décio Pinheiro Barros Júnior\",\"doi\":\"10.1089/end.2024.0060\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Introduction:</i></b> The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. <b><i>Methods:</i></b> A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration <i>vs</i> its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, <i>I</i><sup>2</sup> statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. <b><i>Results:</i></b> Eleven studies encompassing 1074 patients undergoing URS 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; <i>I</i><sup>2</sup> = 6%; PI 0.10-0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08-4.23; <i>I</i><sup>2</sup> = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; <i>I</i><sup>2</sup> = 0%) and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; <i>I</i><sup>2</sup> = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; <i>I</i><sup>2</sup> = 91%; PI 0.47-2.59). <b><i>Conclusion:</i></b> Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.</p>\",\"PeriodicalId\":15723,\"journal\":{\"name\":\"Journal of endourology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of endourology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1089/end.2024.0060\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of endourology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/end.2024.0060","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
导言:在输尿管镜检查过程中使用输尿管入路鞘(UAS)与输尿管损伤的风险有关。术前使用α1-受体阻滞剂可通过诱导输尿管松弛而减轻此类病变,这也有助于改善其他手术效果:方法: 我们在 MEDLINE、Embase 和 Cochrane 数据库中进行了全面的文献检索,比较了在接受输尿管镜检查的未预先植入支架的成年患者中术前使用 α1-受体阻滞剂与不使用α1-受体阻滞剂的情况。使用风险比 (RR) 和几率比 (OR) 以及 95% 的置信区间对二元结果进行评估。异质性采用 Cochran Q 检验、I2 统计量和预测区间 (PI) 进行衡量。所有结果均采用 DerSimonian 和 Laird 随机效应模型:共纳入了 11 项研究,涵盖 1074 名接受输尿管镜检查的患者,其中 522 人(48.60%)在术前接受了α1-受体阻滞剂治疗。术前使用α1-受体阻滞剂可减少输尿管的明显损伤(RR 0.30;95% CI 0.17-0.53;I²=6%;PI 0.10-0.88),并提高输尿管通道鞘插入的平均成功率(OR 2.14;95% CI 1.08-4.23;I²=23%;PI 0.51-8.93)。在接受输尿管镜碎石术的患者中,药物也减少了总并发症(RR 0.62;95% CI 0.46-0.84;I²=0%)和 Clavien-Dindo III 级或以上并发症(RR 0.16;95% CI 0.04-0.69;I²=0%)。无结石率(RR 1.10;95% CI 0.86-1.40;I²=91%;PI 0.47-2.59)组间无明显差异:结论:术前使用α1-受体阻滞剂可减少使用UAS时输尿管的明显损伤,并减少输尿管镜碎石术中的并发症。然而,它们对成功插入 UAS 的影响仍不确定。建议考虑在使用 UAS 进行输尿管镜检查的患者术前使用 α1 受体阻滞剂。
Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis.
Introduction: The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. Methods: A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration vs its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. Results: Eleven studies encompassing 1074 patients undergoing URS 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 UAS insertion (OR 2.14; 95% CI 1.08-4.23; I2 = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), 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%), but 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 UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.
期刊介绍:
Journal of Endourology, JE Case Reports, and Videourology are the leading peer-reviewed journal, case reports publication, and innovative videojournal companion covering all aspects of minimally invasive urology research, applications, and clinical outcomes.
The leading journal of minimally invasive urology for over 30 years, Journal of Endourology is the essential publication for practicing surgeons who want to keep up with the latest surgical technologies in endoscopic, laparoscopic, robotic, and image-guided procedures as they apply to benign and malignant diseases of the genitourinary tract. This flagship journal includes the companion videojournal Videourology™ with every subscription. While Journal of Endourology remains focused on publishing rigorously peer reviewed articles, Videourology accepts original videos containing material that has not been reported elsewhere, except in the form of an abstract or a conference presentation.
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