PMID- 33741297
OWN - NLM
STAT- MEDLINE
DCOM- 20220608
LR  - 20220914
IS  - 2405-4569 (Electronic)
IS  - 2405-4569 (Linking)
VI  - 8
IP  - 2
DP  - 2022 Mar
TI  - Silodosin for Prevention of Ureteral Injuries Resulting from Insertion of a 
      Ureteral Access Sheath: A Randomized Controlled Trial.
PG  - 572-579
LID - S2405-4569(21)00066-3 [pii]
LID - 10.1016/j.euf.2021.03.009 [doi]
AB  - BACKGROUND: The ureteral access sheath (UAS) is an ancillary device widely used 
      by urologists, but acute ureter injury may occur following its insertion. 
      Preoperative selective oral alpha1-blockers can reduce intraureteral pressure, and 
      prevent ureteral wall injury during UAS insertion. OBJECTIVE: To compare 
      perioperative data of patients who underwent flexible ureterorenoscopy (fURS) 
      with UAS with and without premedication with silodosin. DESIGN, SETTING, AND 
      PARTICIPANTS: Single-blind, 100 patients from a single institution who underwent 
      retrograde intrarenal surgery for kidney and upper ureter stone removal were 
      prospectively allocated from May 2018 to March 2019. INTERVENTION: The 
      experimental groups received silodosin for 3 d preoperatively. OUTCOME 
      MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint included ureteral 
      injuries after UAS insertion that were assessed according to endoscopic 
      classification. The secondary endpoint was an evaluation of whether premedication 
      with silodosin had any effect on postoperative outcomes. RESULTS AND LIMITATIONS: 
      A total of 44 and 43 patients were randomly assigned to the control and 
      experimental groups, respectively. Silodosin prevented significant postoperative 
      ureteral injury involving the smooth muscle layer more successfully than in the 
      control group (9.3% vs 27.3%; p = 0.031). There was no significant difference in 
      the overall complication rate as determined by the modified Clavien-Dindo 
      classification system and the computed tomography scan stone-free rate 
      postoperatively. Patients who received silodosin before fURS reported lower pain 
      scores than those in the control group using a visual analog scale (p = 0.009). 
      Limitation included a lack of placebo comparison. CONCLUSIONS: Our data suggest 
      that preoperative silodosin protects against significant ureteral injury related 
      to UAS insertion during fURS and decreases postoperative pain level. Silodosin 
      premedication might be an effective and safe technique to replace prestenting. 
      PATIENT SUMMARY: We investigated the preventive effect of an alpha-blocker against 
      perioperative complication caused by ureteral access sheath inserted during 
      flexible ureterorenoscopy. Taking silodosin before surgery prevented ureter wall 
      injury during surgery and immediately improved postoperative pain.
CI  - Copyright (c) 2021. Published by Elsevier B.V.
FAU - Kim, Jong Keun
AU  - Kim JK
AD  - Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 
      Republic of Korea.
FAU - Choi, Chang Il
AU  - Choi CI
AD  - Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 
      Republic of Korea.
FAU - Lee, Seong Ho
AU  - Lee SH
AD  - Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 
      Republic of Korea.
FAU - Han, Jun Hyun
AU  - Han JH
AD  - Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 
      Republic of Korea.
FAU - Shim, Young Suk
AU  - Shim YS
AD  - Department of Pediatrics, AjouUniversity Hospital, Ajou University School of 
      Medicine, Suwon, Republic of Korea. Electronic address: royjays@aumc.ac.kr.
FAU - Choo, Min Soo
AU  - Choo MS
AD  - Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 
      Republic of Korea; Department of Urology, Seoul Metropolitan Government Seoul 
      National University Boramae Medical Center, Seoul, Republic of Korea. Electronic 
      address: mschoo@snu.ac.kr.
CN  - Young Endourological Study group
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20210323
PL  - Netherlands
TA  - Eur Urol Focus
JT  - European urology focus
JID - 101665661
RN  - 0 (Indoles)
RN  - CUZ39LUY82 (silodosin)
SB  - IM
CIN - J Urol. 2021 Aug;206(2):470-472. PMID: 33971728
CIN - J Urol. 2021 Sep;206(3):765-767. PMID: 34111940
MH  - Humans
MH  - Indoles
MH  - Male
MH  - Pain, Postoperative
MH  - Single-Blind Method
MH  - *Ureter/surgery
MH  - Ureteroscopy/adverse effects/methods
OTO - NOTNLM
OT  - Adrenergic alpha-antagonists
OT  - Kidney calculi
OT  - Ureter/injuries
OT  - Ureteral access sheath
OT  - Ureteroscopy
EDAT- 2021/03/21 06:00
MHDA- 2022/06/09 06:00
CRDT- 2021/03/20 05:55
PHST- 2020/12/29 00:00 [received]
PHST- 2021/02/14 00:00 [revised]
PHST- 2021/03/02 00:00 [accepted]
PHST- 2021/03/21 06:00 [pubmed]
PHST- 2022/06/09 06:00 [medline]
PHST- 2021/03/20 05:55 [entrez]
AID - S2405-4569(21)00066-3 [pii]
AID - 10.1016/j.euf.2021.03.009 [doi]
PST - ppublish
SO  - Eur Urol Focus. 2022 Mar;8(2):572-579. doi: 10.1016/j.euf.2021.03.009. Epub 2021 
      Mar 23.