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Preoperative alpha-blockers to facilitate ureteral access sheath (UAS) insertion: a systematic review and meta-analysis

  • Muhlis Yusuf ,
  • Niwanda Yogiswara ,
  • Muhammad Rifki Setiawan ,
  • Sirin Salsabila ,
  • Mohammad Ayodhia Soebadi ,
  • Soetojo Wirjopranoto ,


Abstract

Background: Recent studies have proposed the use of preoperative alpha-blockers to facilitate urethral access sheath (UAS) placement, but the definite role of this practice is still unclear. We aimed to evaluate the efficacy and safety of alpha-blocker use for UAS placement in intrarenal endoscopic procedures.

Methods: The course of this study followed the preferred reporting items for systematic review and meta-analyses guidelines. Articles investigating the use of preoperative alpha-blockers for patients who underwent intrarenal endoscopic procedures were systematically reviewed from PubMed, EMBASE, and Scopus databases. Odds ratio (OR) with 95% confidence intervals (CIs) were applied for the outcome estimates. Analyses were performed with RevMan 5.4 software. The protocol of this study is enlisted in the registry of PROSPERO (CRD42022342811).

Results: Six articles comprising 462 study populations were included in the review. Meta-analysis on the success rate of UAS placement showed a significant advantage of the alpha-blocker group compared to the control group (OR: 3.83; 1.83-8.00; 95% CI; p = 0.0004). Ureteral wall trauma was higher in the control group (OR: 0.38; 0.17-0.84; 95% CI; p = 0.02). Furthermore, there was no clear association between the UAS size and the success rate of UAS insertion.

Conclusion: Preoperative alpha-blockers may increase the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures.

Keywords: alpha-blockers ureteral access sheath flexible ureterorenoscopy retrograde intrarenal surgery

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How to Cite

Yusuf, M., Yogiswara, N. ., Setiawan, M. R. ., Salsabila, S. ., Soebadi, M. A., & Wirjopranoto, S. . (2023). Preoperative alpha-blockers to facilitate ureteral access sheath (UAS) insertion: a systematic review and meta-analysis. Bali Medical Journal, 12(1), 291–298. https://doi.org/10.15562/bmj.v12i1.4072
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Muhlis Yusuf
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Niwanda Yogiswara
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Muhammad Rifki Setiawan
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Sirin Salsabila
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Mohammad Ayodhia Soebadi
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Soetojo Wirjopranoto
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