Adjunctive Doxazosin before Ureterolithotripsy to Improve Successful Access Rate: A Retrospective Analysis.

Background: Ureteroscopic lithotripsy using a semi-rigid ureteroscope is the standard treatment for urinary stones. Doxazosin-an alpha-1 adrenergic receptor blocker-relaxes ureteral smooth muscles, reducing peristalsis and contraction frequency. This study aimed to evaluate the efficacy and safety of adjunctive doxazosin before semi-rigid ureteroscopy and retrograde intrarenal surgery (RIRS) for urinary stones.

Methods: We analyzed the data of patients who underwent semi-rigid ureteroscopy and RIRS between January 1, 2022 and December 31, 2022. The patients were divided into four groups: Patients who underwent semi-rigid ureteroscopy with or without doxazosin preoperatively and patients who underwent RIRS with or without doxazosin preoperatively. We assessed the patient's age and sex; Stone laterality, location, and maximum diameter; Successful access rate; And surgical complications. Pearson's chi-square, Fisher's exact, and Student's t-tests were used for the statistical analyses.

Results: The final analysis included 266 patients. Patient's age and sex and stone laterality, location, and maximal diameter were similar between the groups. In the semi-rigid ureteroscopic lithotripsy group, the successful access rate was higher in patients who received doxazosin (95%) compared with those who did not (79.69%) (p = 0.023). In the RIRS group, the successful access rate was higher in patients who received doxazosin (84.09%) compared with those who did not (57.41%) (p = 0.040). In the RIRS group, the duration of postoperative double-J stent placement in patients who received doxazosin was significantly shorter than that in those who did not (p = 0.010). Notably, no serious drug-related adverse events were observed.

Conclusions: Doxazosin can be safely and effectively used before semi-rigid and flexible ureteroscopy.