Advertisement

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

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Alpha-blocker Tamsulosin Ureteral access sheath Ureteroscopy Nephrolithiasis 

Notes

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.

References

  1. 1.
    Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT (2014) Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database of Syst Rev.  https://doi.org/10.1002/14651858.CD008509.pub2 CrossRefGoogle Scholar
  2. 2.
    Hollingsworth JM, Canales BK, Rogers MAM et al (2016) Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 355:i6112CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ye Z, Zeng G, Yang H, Tang K, Zhang X, Li H et al (2017) Efficacy and safety of tamsulosin in medical expulsive therapy for distal ureteral stones with renal colic: a multicenter, randomized, double-blind, Placebo-controlled Trial. Eur Urol S0302–2838(17):30972–30977.  https://doi.org/10.1016/j.eururo.2017.10.033 CrossRefGoogle Scholar
  4. 4.
    Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K (2007) Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol 14:749–753CrossRefPubMedGoogle Scholar
  5. 5.
    Johnson LJ, Davenport D, Venkatesh R (2015) Effects of alpha-blockade on ureteral peristalsis and intrapelvic pressure in an in vivo stented porcine model. J Endourol 30:417–421CrossRefGoogle Scholar
  6. 6.
    Nakada SY, Coyle TLC, Ankem MK, Moon TD, Jerde TJ (2007) Doxazosin relaxes ureteral smooth muscle and inhibits epinephrine-induced ureteral contractility in vitro. Urology 70:817–821CrossRefPubMedGoogle Scholar
  7. 7.
    Troxel SA, Jones AW, Magliola L, Benson JS (2006) Physiologic effect of nifedipine and tamsulosin on contractility of distal ureter. J Endourol 20:565–568CrossRefPubMedGoogle Scholar
  8. 8.
    Traxer O, Wendt-Nordahl G, Sodha H et al (2015) Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study. World J Urol 33:2137–2144CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Vanlangendonck R, Landman J (2004) Ureteral access strategies: pro-access sheath. Urol Clin North Am 31:71–81CrossRefPubMedGoogle Scholar
  10. 10.
    Monga M, Dretler SP, Landman J, Slaton JW, Conradie MC, Clayman RV (2002) Maximizing ureteroscope deflection: “play it straight”. Urology 60(5):902–905CrossRefPubMedGoogle Scholar
  11. 11.
    Rehman J, Monga M, Landman J et al (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61:713–718CrossRefPubMedGoogle Scholar
  12. 12.
    Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165(3):789–793CrossRefPubMedGoogle Scholar
  13. 13.
    Wu NZ, Auge BK, Preminger GM (2001) Simplified ureteral stent placement with the assistance of a ureteral access sheath. J Urol 166(1):206–208CrossRefPubMedGoogle Scholar
  14. 14.
    Kaplan AG, Lipkin ME, Scales CD Jr, Preminger GM (2015) Use of ureteral access sheaths in ureteroscopy. Nat Rev Urol a13(3):135–140.  https://doi.org/10.1038/nrurol.2015.271 CrossRefGoogle Scholar
  15. 15.
    L’esperance JO, Ekeruo WO, Scales CD Jr et al (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66:252–255CrossRefPubMedGoogle Scholar
  16. 16.
    Auge BK, Pietrow PK, Lallas CD et al (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18:33–36CrossRefPubMedGoogle Scholar
  17. 17.
    Landman J, Venkatesh R, Ragab M et al (2002) Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath. Urology 60:584–587CrossRefPubMedGoogle Scholar
  18. 18.
    Ng YH, Somani BK, Dennison A et al (2010) Irrigant flow and intrarenal pressure during flexible ureteroscopy: the effect of different access sheaths, working channel instruments, and hydrostatic pressure. J Endourol 24:1915–1920CrossRefPubMedGoogle Scholar
  19. 19.
    Mariappan P, Smith G, Moussa SA, Tolley DA (2006) One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int 98(5):1075–1079CrossRefPubMedGoogle Scholar
  20. 20.
    Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline. J Urol 196(4):1153–1160.  https://doi.org/10.1016/j.juro.2016.05.090 CrossRefPubMedGoogle Scholar
  21. 21.
    Schoenthaler M, Wilhelm K, Kuehhas FE et al (2012) Postureteroscopic lesion scale: a new management modified organ injury scale—evaluation in 435 ureteroscopic patients. J Endourol 26(11):1425–1430CrossRefPubMedGoogle Scholar
  22. 22.
    Finch W, Johnston R, Shaida N et al (2014) Measuring stone volume—three-dimensional software reconstruction or an ellipsoid algebra formula? BJU Int 113:610–614CrossRefPubMedGoogle Scholar
  23. 23.
    Ito H, Kawahara T, Terao H et al (2013) Utility and limitation of cumulative stone diameter in predicting urinary stone burden at flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. PLoS One 8:e65060.  https://doi.org/10.1371/journal.pone.0065060 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Bone RC, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655CrossRefPubMedGoogle Scholar
  26. 26.
    Sigala S, Dellabella M, Milanese G et al (2005) Evidence for the presence of α1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn 24:142–148CrossRefPubMedGoogle Scholar
  27. 27.
    Vernez SL, Okhunov Z, Wikenheiser J et al (2017) Precise characterization and 3-dimensional reconstruction of the autonomic nerve distribution of the human ureter. J Urol 197:723–729CrossRefPubMedGoogle Scholar
  28. 28.
    Anon (2006) Flomax (tamsulosin hydrochloride) capsules, 0.4 mg prescribing information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/020579s016lbl.pdf. Accessed 20 Feb 2017
  29. 29.
    Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189(2):580–584CrossRefPubMedGoogle Scholar
  30. 30.
    Delvecchio FC, Auge BK, Brizuela RM et al (2003) Assessment of stricture formation with the ureteral access sheath. Urology 61:518–522CrossRefPubMedGoogle Scholar
  31. 31.
    Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51(4):899–906CrossRefPubMedGoogle Scholar

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

Personalised recommendations