Hu Q, Yuan C, Shen S, Jian Z, Jin X, Ma Y, Li H, Wang K. Are adrenergic α1- antagonists beneficial for the access of retrograde ureteral access sheath or semi-rigid ureteroscope access? A systematic review and meta-analysis.
Front Surg 2023;
9:1055904. [PMID:
36684219 PMCID:
PMC9849750 DOI:
10.3389/fsurg.2022.1055904]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction
To evaluate the clinical benefit of preoperative adrenergic α1-antagonist therapy in the management of upper urinary calculi.
Materials and methods
Publications were searched for The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE until 1 March 2022 that related to the adrenergic α1- antagonist intake as adjunctive therapy before retrograde surgery. Dichotomous data were reported with risk ratios (RR) with 95% confidence intervals (CIs) and the continuous data were reported with mean difference (MD) with 95% CIs.
Results
There were nine studies with 867 patients included in this meta-analysis. Preoperative adrenergic α1- antagonists could significantly elevate the compared with the placebo. Higher successful access rate to the stone was found in patients who received preoperative adrenergic α1- antagonists than those who received the placebo (RR 1.24; 95% CI 1.17-1.33). Besides, the application of preoperative adrenergic α1- antagonists can also elevate 4th-week stone-free rate (RR 1.20; 95% CI 1.12-1.28), decrease postoperative analgesia (RR 0.30;95% CI 0.20-0.46) and result in a lower risk of overall complications (RR 0.38; 95% CI 0.24-0.61).
Conclusion
Preoperative adjunctive adrenergic α1- antagonist therapy is effective and safe in the management of retrograde surgery with a higher successful access rate and lower risk of severe complications.
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