Login to Access Video or Poster Abstract: MP66-02
Sources of Funding: None

Introduction

Alpha-1 adrenergic receptors are densely located in the intramural ureter, which can be too narrow to navigate during ureteroscopy (URS). Balloon dilation of the ureteral orifice (UO) is not recommended in pediatric patients, as it may lead to vesicoureteral reflux, ureteral stricture, or rupture. Therefore, ureteral stents (US) are usually placed for passive dilation resulting in another procedure. We aim to evaluate whether pre-operative tamsulosin increases the rate of ureteral navigation for URS.

Methods

We retrospectively reviewed all pediatric patients who underwent URS at our institution from January 2013 to October 2016. Procedures were identified by searching the electronic medical records for cases billed as URS. All cases were performed by a single surgeon using a standard approach for UO navigation based on location of the stone, semi-rigid ureteroscope (Wolf 4.5 Fr) for distal and mid ureteral stones, and flexible ureteroscope (Storz 7.5 Fr) with or without a ureteral access sheath (Cook 9.5 Fr) for proximal ureteral and kidney stones. Patients were separated into 2 groups: those who took tamsulosin 0.4 mg daily for at least 48 hours pre-operatively and those who did not take tamsulosin pre-operatively. Exclusion criteria included any patient who had a US placed previously. The student T test, Z test, and chi square test were used for statistical analysis.

Results

A total of 55 patients underwent URS with 22 taking pre-operative tamsulosin, 19 without tamsulosin, and 14 patients were excluded. There was no significant difference between the groups with consideration to age and weight of the patients and size or location of the stones. We were able to navigate the ureter in 19 of 22 patients (86.4%) who took tamsulosin and 10 of 19 patients (52.6%) who did not take tamsulosin (p = 0.018). Further stratification was made between distal and proximal stone location. We were able to navigate the ureter in 9 of 10 patients (90.0%) in the tamsulosin group and 1 of 4 patients (25.0%) in the no tamsulosin group for mid and distal stones (p = 0.015). For proximal ureteral and renal stones, we were able to navigate the ureter in 10 of 12 patients (83.3%) in the tamsulosin group and 9 of 15 patients (60.0%) in the no tamsulosin group (p = 0.187). We did not observe any adverse effect from tamsulosin.

Conclusions

Pre-operative tamsulosin did significantly increase the success rate of ureteral navigation for URS, particularly during semi-rigid ureteroscopy for distal or mid ureteral stones, thus decreasing the number of surgeries in our pediatric patients.

Funding

None