Does preoperative alpha-blocker use affect the results of flexible ureterorenoscopy?

Objective: To evaluate the effect of alpha-blocker therapy during flexible ureterorenoscopy (F-URS) on the treatment of upper urinary tract stones.

Methods: A retrospective analysis was conducted on 476 patients who underwent F-URS at the Department of Urology between January 2010 and January 2017. Data collected included alpha-blocker use, stone size, stone location, patient age and gender, success or failure of ureteral access sheath (UAS) placement, ability to reach the stone during the procedure, postoperative stone-free status, and complication rates. Patients were divided into two groups: alpha-blocker users (n = 90, 18.9%) and non-users (n = 386, 81.1%).

Results: No significant differences were observed in gender distribution (P = 0.86) or stone size (P = 0.21) between the two groups. Alpha-blocker users had a lower complication rate (P = 0.022), a higher rate of successful stone access during the procedure (P = 0.007), and a higher postoperative stone-free rate (P = 0.01) compared to non-users. Among alpha-blocker users, tamsulosin and silodosin were associated with higher stone clearance rates (P = 0.046 and P = 0.037, respectively).

Conclusions: Alpha-blocker therapy during F-URS for upper urinary tract stones is associated with improved outcomes, including higher stone access rates, reduced complications, and increased stone-free rates. These findings suggest that alpha-blockers, particularly tamsulosin and silodosin, may enhance the efficacy and safety of F-URS.