Does Silodosin Improve Primary Ureteroscopy Access and Outcomes: Meta-Analysis of Randomized Controlled Trials.

IF 2.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Mohammed Zain Ulabedin Adhoni, Muhammad Haider, Bhaskar Somani, Zubeir Ali
{"title":"Does Silodosin Improve Primary Ureteroscopy Access and Outcomes: Meta-Analysis of Randomized Controlled Trials.","authors":"Mohammed Zain Ulabedin Adhoni, Muhammad Haider, Bhaskar Somani, Zubeir Ali","doi":"10.1089/end.2024.0413","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Background:</i></b> Ureteroscopy (URS) is a widely utilized procedure for the management of urinary stones, though failed access due to ureteral orifice tightness or spasms can be a potential outcome. Silodosin, an alpha-1A adrenergic receptor antagonist, has shown promise in recent randomized controlled trials (RCTs) in improving URS outcomes by relaxing ureteral smooth muscle. <b><i>Objective:</i></b> This systematic review and meta-analysis aims to determine whether preoperative administration of silodosin enhances ureteroscopy outcomes, including ureteral access rates, operative time, complication rates, and stone-free rates. <b><i>Methods:</i></b> After PROSPERO registration, a comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted for RCTs comparing silodosin with placebo or no medication before URS. Data extraction and bias assessment were performed independently by two reviewers. Statistical analysis was undertaken by Review Manager V5.4, employing random-effects models for heterogeneous variables. <b><i>Results:</i></b> Eight RCTs with a total of 892 patients (416 in the silodosin group and 476 in the control group) met the inclusion criteria. Silodosin significantly reduced operative time by 15.74 minutes (<i>p</i> < 0.00001). The access rate was higher in the silodosin group (96.9%) compared with the control group (87.2%)(<i>p</i> = 0.0004). Total complication rates were lower in the silodosin group (14.39% <i>vs</i> 27.47%, <i>p</i> < 0.00001), as were moderate to significant complications (5.0% <i>vs</i> 11.7%, <i>p</i> = 0.003). Stone-free rates were also higher in the silodosin group (92.16% <i>vs</i> 81.5%, <i>p</i> < 0.0001). <b><i>Conclusion:</i></b> Preoperative administration of silodosin significantly improves URS outcomes by reducing operative time, increasing access rates, decreasing complication rates, and enhancing stone-free rates. These findings support the integration of silodosin into clinical practice guidelines for URS, potentially improving procedural efficiency and patient outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-09-16","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.2024.0413","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

Abstract

Background: Ureteroscopy (URS) is a widely utilized procedure for the management of urinary stones, though failed access due to ureteral orifice tightness or spasms can be a potential outcome. Silodosin, an alpha-1A adrenergic receptor antagonist, has shown promise in recent randomized controlled trials (RCTs) in improving URS outcomes by relaxing ureteral smooth muscle. Objective: This systematic review and meta-analysis aims to determine whether preoperative administration of silodosin enhances ureteroscopy outcomes, including ureteral access rates, operative time, complication rates, and stone-free rates. Methods: After PROSPERO registration, a comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted for RCTs comparing silodosin with placebo or no medication before URS. Data extraction and bias assessment were performed independently by two reviewers. Statistical analysis was undertaken by Review Manager V5.4, employing random-effects models for heterogeneous variables. Results: Eight RCTs with a total of 892 patients (416 in the silodosin group and 476 in the control group) met the inclusion criteria. Silodosin significantly reduced operative time by 15.74 minutes (p < 0.00001). The access rate was higher in the silodosin group (96.9%) compared with the control group (87.2%)(p = 0.0004). Total complication rates were lower in the silodosin group (14.39% vs 27.47%, p < 0.00001), as were moderate to significant complications (5.0% vs 11.7%, p = 0.003). Stone-free rates were also higher in the silodosin group (92.16% vs 81.5%, p < 0.0001). Conclusion: Preoperative administration of silodosin significantly improves URS outcomes by reducing operative time, increasing access rates, decreasing complication rates, and enhancing stone-free rates. These findings support the integration of silodosin into clinical practice guidelines for URS, potentially improving procedural efficiency and patient outcomes.

西洛多辛是否能改善初级输尿管镜检查通道和结果:随机对照试验的 Meta 分析。
背景:输尿管镜检查(URS)是一种广泛应用于治疗泌尿系结石的手术,但由于输尿管口狭窄或痉挛而导致的检查失败可能是一种潜在的结果。西洛多辛是一种α-1A肾上腺素能受体拮抗剂,在最近的随机对照试验(RCTs)中显示出通过放松输尿管平滑肌来改善尿路镜检查结果的前景:本系统综述和荟萃分析旨在确定术前服用西洛多辛是否能提高输尿管镜检查效果,包括输尿管通畅率、手术时间、并发症发生率和无结石率:方法: 在 PROSPERO 注册后,对 PubMed、EMBASE 和 Cochrane 图书馆进行了全面检索,以寻找在 URS 前比较西洛多辛与安慰剂或不用药的随机对照试验 (RCT)。数据提取和偏倚评估由两名审稿人独立完成。统计分析由 Review Manager V5.4 进行,采用随机效应模型对异质性变量进行分析:共有892名患者(西洛多辛组416人,对照组476人)的8项研究符合纳入标准。西洛多辛明显缩短了 15.74 分钟的手术时间(p < 0.00001)。西洛多辛组的手术通畅率(96.9%)高于对照组(87.2%)(p = 0.0004)。西洛多辛组的总并发症发生率较低(14.39% 对 27.47%,p < 0.00001),中重度并发症发生率也较低(5.0% 对 11.7%,p = 0.003)。西洛多辛组的无结石率也更高(92.16% 对 81.5%,P < 0.0001):结论:术前服用西洛多辛可缩短手术时间、提高通路率、降低并发症发生率并提高无结石率,从而显著改善 URS 的疗效。这些研究结果支持将西洛多辛纳入尿路造影术的临床实践指南,从而提高手术效率和患者预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of endourology
Journal of endourology 医学-泌尿学与肾脏学
CiteScore
5.50
自引率
14.80%
发文量
254
审稿时长
1 months
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. Journal of Endourology coverage includes: The latest laparoscopic, robotic, endoscopic, and image-guided techniques for treating both benign and malignant conditions Pioneering research articles Controversial cases in endourology Techniques in endourology with accompanying videos Reviews and epochs in endourology Endourology survey section of endourology relevant manuscripts published in other journals.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信