Comparative study between preoperative stenting versus preoperative Tamsulosin in the ureteroscopic management of upper and middle ureteral stones in adults

Objective To compare the safety and efficacy of preoperative stenting versus preoperative Tamsulosin versus direct ureteroscopy (URS) in the ureteroscopic management of upper or middle ureteral calculi. Patients and methods This study included 60 patients with upper or middle ureteral calculi less than 20 mm scheduled for semirigid URS and pneumatic lithotripsy at Urology Department, Ain Shams University Hospitals and Dar Alshifa Hospital in Cairo between February 2019 and February 2020. Patients were randomized into three equal groups: A (preoperative stenting), B (preoperative Tamsulosin), and C (direct URS). Results The mean operative time was 53.65±9.29 min in group B shorter than group A 54.30±8.34 min and group C 62.25±12.05 min (P=0.014). Postoperative colic was 5% in group B less than group A 15% and group C 35% (P=0.044). Stone-free rate was 95% in group A more than group B 85% and group C 60% (P=0.017). Success rate was 95% in group A more than group B 90% and group C 65% (P=0.002). Ureteroscope access was 100% in group A more than group B 90% and group C 35% (P=0.006). Hospitalization time was 1.25±0.34 days in group A shorter than group B 1.55±0.55 days and group C 1.80±0.47 days (P=0.002). Patients needed to do auxiliary Double J stent (DJ), repeat URS, extracorporeal shockwave lithotripsy, or open ureterolithotomy were 0, 0, 5, and 0% in group A, 15, 0, 10%, and 0% in group B, and 40, 20, 10, and 5% in group C (P=0.004, 0.014, 0.804, and 0.362), respectively. Conclusion Use of preoperative Tamsulosin or stenting before semirigid URS and pneumatic lithotripsy in the ureteroscopic management of upper or middle ureteral stones in adults is safe and effective more than direct URS. Preoperative Tamsulosin significantly reduced operative time and postoperative colic. While preoperative ureteral stenting significantly improved stone-free rates, success rates, ureteroscopic access and hospitalization time, and need for ureteral dilatation and auxiliary procedures.