Introduction: Ureteral access sheath (UAS) use during ureteroscopy has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents as 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 that compared preoperative α1-blockers administration versus its non-use in adult patients without pre-stenting undergoing ureteroscopy. Binary outcomes were evaluated using risk ratios (RR) and odds ratios (OR) with 95% confidence intervals. Heterogeneity was measured with the Cochran Q test, I2 statistics, and prediction intervals (PI). A DerSimonian and Laird random-effects model was utilized for all outcomes.
Results: Eleven studies encompassing 1074 patients undergoing ureteroscopy 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 ureteral access sheath insertion (OR 2.14; 95% CI 1.08-4.23; I²=23%; PI 0.51-8.93). In patients undergoing ureteroscopy lithotripsy, 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%). 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 ureteroscopy lithotripsy procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in patients undergoing ureteroscopy with UAS is advisable.