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

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.

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.

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.

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