Effect of Preoperative Alpha-blockers on Successful Insertion Ureteral Access Sheath and Reduce Ureteral Injury in Non-prestented Patients During RIRS. Assessment of Factors for Successful Ureteral Access Sheath Insertion.

NCT ID: NCT07202923

Last Updated: 2025-11-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

140 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-07-09

Study Completion Date

2024-06-02

Brief Summary

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The aim of the study is to evaluate the effect of preoperative taking alpha-blockers (tamsulosin or silodosin) on the success rate of ureteral access sheath (UAS) insertion and the degree of ureteral injury during RIRS in non-prestented patients.

The results showed that patients who received alpha-blockers had a higher rate of successful UAS insertion and a lower degree of ureteral injury compared to non-prestented patients. In addition, patients with a BMI greater than 25 kg/m² and those older than 59 years demonstrated a higher success rate of UAS insertion and lower degree of ureteral injury.

Detailed Description

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Study Title:

Effect of Preoperative Tamsulosin and Silodosin on Successful Insertion Ureteral Access Sheath and Reduce Ureteral Injury in Non-Prestented Patients During Retrograde Intrarenal Surgery (RIRS). Assessment of factors for successful ureteral access sheath insertion. Randomized clinical trial.

Study Design:

Prospective, randomized, open-label, controlled trial with four parallel arms. Conducted from July 2021 to June 2024.

Study Center:

Department of Urology, St. Luke's Clinical Hospital, St. Petersburg, Russia

Study Population:

140 patients, divided into four equal groups of 35 people each: Group I (Tamsulosin): Non-prestented patients receiving 0.4 mg of Tamsulosin daily for 7 days before RIRS.

Group II (Silodosin): Non-prestented patients receiving 8 mg of Silodosin daily for 7 days before RIRS.

Group III: Prestented patients. Group IV: Control group (non-prestented patients)

Interventions:

All patients received antibiotic prophylaxis with third-generation cephalosporins 30 minutes before surgery.

RIRS was performed using disposable flexible ureteroscopes. The UAS diameter was 11/13 Fr. Thulium fiber laser was used for lithotripsy. Stone fragmentation was performed in dusting and fragmentation modes, with a total power not exceeding 20 W and a fiber thickness of 200 µm.

Statistical Analysis:

Data were analyzed using Shapiro-Wilk, Mann-Whitney U, Kruskal-Wallis, and chi-square tests with Bonferroni correction (SPSS v26, JMP Pro 17). Statistical significance was set at p\<0.05.

Key Findings:

Comparable baseline characteristics (p\>0.05)

Significantly higher UAS success rates:

Tamsulosin: 31 (88.57%)

Silodosin: 32 (91.43%)

Prestented: 33 (94.29%)

Control: 62.86% (p=0.0008)

Preoperative taking Silodosin significantly reduced degree ureteral injury (p=0.0253).

Patients receiving alpha-blockers experienced less postoperative pain compared to the control group (p\<0.0001) and less inflammatory changes in blood tests compared to prestented patients (WBC: p=0.0002; CRP: p\<0.0001)

Patients with BMI ≥ 25 kg/m² and age ≥ 59 years had a higher success rate of UAS insertion (p\<0,0001).

Patients with BMI ≥ 25 kg/m² and age ≥ 59 years have a lower degree of ureteral injury (p\<0,0001).

Conclusions:

Preoperative taking of alpha-blockers (Tamsulosin or Silodosin) increases the success of UAS insertion.

Silodosin reduces the degree ureteral injury. Patients taking alpha-blockers less postoperative pain and inflammatory changes in blood tests.

A BMI ≥ 25 kg/m² and age ≥ 59 years increase the success of UAS insertion and reduce degree of ureteral injury

Clinical Implications:

This study provides evidence supporting the use of alpha-blockers, particularly silodosin, for passive ureteral dilation prior to RIRS in non-prestented patients, potentially reducing compications and improving patient outcomes.

Conditions

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Urolithiasis Ureteral Injury Ureteral Access Sheath Retrograde Intrarenal Surgery

Study Design

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Observational Model Type

OTHER

Study Time Perspective

RETROSPECTIVE

Study Groups

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Group I (Tamsulosin)

Non-prestented patients receiving 0.4 mg of Tamsulosin daily for 7 days before RIRS.

No interventions assigned to this group

Group II (Silodosin)

Non-prestented patients receiving 8 mg of Silodosin daily for 7 days before RIRS.

No interventions assigned to this group

Group III

Prestented patients

No interventions assigned to this group

Group IV

Control group (non-prestented patients)

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Patients aged 18 years and older
* Kidney stone size: ≤2 cm
* Stone density \>1000 Hounsfield units
* Sterile urine culture

Exclusion Criteria

* Congenital anomalies of the urinary tract
* Urinary tract infections
* Upper urinary tract obstruction
* Prior reconstructive surgeries on the upper urinary tract
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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St. Luke's Clinical Hospital, Russia

OTHER

Sponsor Role lead

Responsible Party

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Mikheev Yury

urologist, St. Luke's Clinical Hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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St. Luke's Clinical Hospital

Saint Petersburg, Outside U.S./Canada, Russia

Site Status

Countries

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Russia

Related Links

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https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox

Complete study data is available upon formal request by email . All legitimate data inquiries will be processed in accordance with applicable privacy regulations.

Other Identifiers

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№19/2

Identifier Type: -

Identifier Source: org_study_id

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