Effect of Preoperative Silodosin on Ureteric Dilatation in Retrograde Intrarenal Surgery

Abstract Background Selective alpha blockers have been used for treatment for ureteric stones as medical expulsive therapy (MET). Recently they have been successfully used in passive ureteric dilatation before semirigid ureteroscopy. Objective This study enables us to know the role of silodosin in ureteric dilatation to facilitate ureteral access sheath placement in Retrograde Intrarenal Surgery (RIRS) with flexible ureteroscopy (F-URS). Patients and Methods A total of 120 patients with renal or upper ureteric stone of 2 cm or less were enrolled, after consenting each of them and divided into two groups; group A (study group) that included 60 patients who underwent flexible ureteroscopy using Ho-YAG laser for stone disintegration. These patients received silodosin ‘one tablet 8 mg per day’ for three days preoperatively and group B (control group) included 60 patients who underwent non-stent ureteroscopy using Ho- YAG laser for stone disintegration. These patients received placebo for three days. All patients were blind to the medication received. Our primary outcome was to assess success of ureteric access sheath placement as follows: spontaneous passage of ureteral access sheath without dilatation or passage of UAS after dilatation or failure of the ureteral access sheath insertion. All cases were classified accordingly. Results Successful placement and spontaneous uretroscopy passage without dilatation were statistically significant higher with less frequency of failed dilatation in silodosin group. Also, operative time, frequency of stone residual, hospital stay and total cost were statistically significant lower. Finally, postoperative complications as pain, hematuria and mucosal injuries were statistically significant lower. Conclusion Preoperative use of silodosin increases the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures.