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The Effect of Preoperative Tamsulosin on Pediatric Ureteroscopic Access: A Multi-Institutional Experience
Kayla M Meyer1,2, Kwesi Asantey3, Jonathan S Ellison3
1University of Michigan Medical School, Ann Arbor, Michigan.
Insights
Preoperative tamsulosin significantly improves flexible ureteroscopy success in children. This medication facilitates pediatric ureteral access, potentially reducing repeat procedures and anesthesia exposure.
Area of Science:
- Pediatric Urology
- Endourology
- Pharmacology
Background:
- Pediatric flexible ureteroscopy can be challenging due to smaller ureteral diameters.
- Tamsulosin is known to aid ureteral access in adults, but its pediatric efficacy is uncertain.
Purpose of the Study:
- To evaluate the efficacy of preoperative tamsulosin in facilitating pediatric ureteral access for flexible ureteroscopy.
Main Methods:
- Multi-institutional retrospective review of 382 pediatric patients (0-17 years) undergoing ureteroscopy for nephrolithiasis.
- Patients received either 0.4 mg tamsulosin daily for at least one week preoperatively or no tamsulosin.
- Exclusion criteria included prior ureteroscopy/stent, semirigid ureteroscopy, or known GU abnormalities.
Main Results:
- The tamsulosin group (n=126) showed a significantly lower failure rate for first-attempt flexible ureteroscopic access (13%) compared to the no-tamsulosin group (n=256, 24%) (P = .010).
- Groups were similar in sex, race, and stone characteristics, but the tamsulosin group was older with a higher BMI.
Conclusions:
- At least one week of preoperative tamsulosin facilitates flexible ureteroscopic access in pediatric patients.
- This finding has clinical implications for reducing repeat procedures and minimizing anesthetic exposure in children.
Introduction:
The ability to perform flexible ureteroscopy in children may be limited because of a smaller pediatric ureterovesical junction and ureteral diameter. Tamsulosin has been shown to improve success rates of ureteral instrumentation in adults. To date, the efficacy of this medication to facilitate pediatric ureteral access remains unclear.
Methods:
We conducted a multi-institutional retrospective review of patients aged 0 to 17 years who underwent ureteroscopy for the treatment of nephrolithiasis from 2013 to 2022. Patients were excluded if they had undergone ureteroscopy or ureteral stent placement within the prior year, underwent semirigid ureteroscopy, or had a known genitourinary abnormality. Study groups included patients prescribed 0.4 mg tamsulosin daily for at least 1 week preoperatively and patients who did not receive tamsulosin.
Results:
There were 382 patients included, with 126 in the tamsulosin group and 256 in the no-tamsulosin group. Although there were no differences in sex, race, and stone characteristics between the 2 groups, the tamsulosin group was significantly older and had a larger BMI. One week of preoperative tamsulosin was associated with a significantly increased success of flexible ureteroscopic access on first attempt ureteroscopy, with a 24% failure in the no-tamsulosin group vs a 13% failure in the tamsulosin group (P = .010).
Conclusions:
Our results expand on prior research and suggest that at least 1 week of preoperative tamsulosin facilitates flexible ureteroscopic access in the pediatric population. These results have significant clinical implications, with the potential to reduce multiple procedures and spare children from repeat anesthetic exposures.
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