Medical impulsive therapy (MIT): the impact of 1 week of preoperative tamsulosin on deployment of 16-French ureteral access sheaths without preoperative ureteral stent placement

  • Kamaljot S. Kaler
  • Shoaib Safiullah
  • Daniel J. Lama
  • Egor Parkhomenko
  • Zhamshid Okhunov
  • Young H. Ko
  • Linda Huynh
  • Roshan M. Patel
  • Jaime Landman
  • Ralph V. Clayman
Original Article


Introduction and objectives

Medical expulsive therapy is based on pharmacologic ureteral relaxation. We hypothesized this concept may facilitate the deployment of the large 16 French (F) ureteral access sheath (UAS) when patients are intentionally pre-treated with oral tamsulosin, i.e., medical impulsive therapy.


We retrospectively analyzed our experience with UAS deployment during endoscopic-guided percutaneous nephrolithotomy in prone position in patients pre-treated for 1 week with oral tamsulosin with a contemporary untreated cohort. Between January 2015 and September 2016, seventy-seven patients without a pre-existing ureteral stent met inclusion criteria. Demographic data, tamsulosin usage, UAS size, deployment failure, ureteral injuries, stone-free rates, and complications were recorded. Univariate and multivariate analysis was conducted to assess the impact of tamsulosin on deployment of the 16F UAS.


There was no statistical difference between the tamsulosin (n = 40) group and non-tamsulosin (n = 37) group in regard to demographic data. The tamsulosin group had a significantly higher percentage of 16F UAS deployment, 87 vs. 43% (p < 0.001), and no significant difference in ureteral injuries (p = 0.228). Univariate and multivariate analysis revealed that tamsulosin significantly increased the odds ratio (9.3 and 19.4, respectively) for successful passage of a 16F UAS. Despite a larger stone volume, there was no significant difference in computed tomography scan complete stone-free rates (29 vs. 42%; p = 0.277) at median post-operative time of only 3 days.


In this retrospective study, 1 week of preoperative tamsulosin was associated with an increase in the deployment of a 16F UAS in patients without preoperative ureteral stent placement.


Alpha-blocker Tamsulosin Ureteral access sheath Ureteroscopy Nephrolithiasis 


Author contributions

KSK: Project development, data collection and analysis, manuscript writing. SS: Data collection and analysis, manuscript writing. DL: Data collection and analysis, manuscript writing. EP: Data collection and analysis, manuscript writing. ZO: Project development, manuscript writing. YHK: Project development, statistical analysis, manuscript writing. LMH: Statistical analysis, manuscript writing. RMP: Project development, manuscript writing. JL: Project development, manuscript writing. RVC: Project development, manuscript writing.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kamaljot S. Kaler
    • 1
  • Shoaib Safiullah
    • 1
  • Daniel J. Lama
    • 1
  • Egor Parkhomenko
    • 1
  • Zhamshid Okhunov
    • 1
  • Young H. Ko
    • 1
    • 2
  • Linda Huynh
    • 1
  • Roshan M. Patel
    • 1
  • Jaime Landman
    • 1
  • Ralph V. Clayman
    • 1
  1. 1.Department of Urology, UCI School of MedicineUniversity of California, IrvineOrangeUSA
  2. 2.Department of UrologyYeungnam University College of MedicineDaeguKorea

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