Document Type : Editorial
1 Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
2 Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Editorial: It was in 2000 that the combination of laser applications with flexible ureteroscopy and retrograde intrarenal surgery (RIRS) applications improved a lot. Nowadays, it is possible to effectively accomplish RIRS operations on upper urinary system stones by using devices that yield high-quality images due to developments in digital technology and increased deflection ability (1). Despite the huge benefits of RIRS, ureteral access sheaths (UAS) that are produced in different diameters ranging between 9.5 and 14 Fr and lengths between 13 and 55 cm can bring some difficulty in the ureter and some uneasiness for the patient. Ureteral access implements include access sheaths, wires, and dilators under debate and upgrading. The safety, effectiveness, and limitations of lithotrites continue to be refined. Stone retrieval devices are moving to be miniaturized, and their cost-effectiveness is at issue (2).
One suggestion to cease such problems of UAS is using the Alpha-blockers. Alpha-blockers (α-blockers) are a class of pharmacological agents that act as antagonists on α-adrenergic receptors (α-adrenoceptors) (3). Generally, α-blockers take arterial blood pressure and central vasomotor control in the autonomic nervous system (4). Some recent suggestions over the benefit of α-blockers to facilitate UAS placement. It is suggested that alpha-blockers raise the spontaneous route of ureteral stones and reduce the severity and frequency of pain, which is more evident in distal ureteral stones. The European association of urology (EAU) Guidelines Panel on Interventional Treatment for Urolithiasis suggested α-blockers (5).
Contradictory, the study by Erturhan and his colleagues discusses the impact of α-blockers over the easier placement of UAS in RIRS (6). In his study, candidate patients of RIRS due to renal stones received Tamsulosin (0.4 mg/day) two weeks before the operation as the case group, contrary to the control group (n=25) underwent the operation without any additional treatment. It was shown that despite the higher successful UAS placement rate, no statistically significant values were reported. Moreover, a multicenter, placebo-controlled, randomized controlled trial and cost-effectiveness analysis of calcium channel blocker (Nifedipine) and Tamsulosin as α-blockers by Pickard et al., Indicated that α-blockers are very unlikely to be cost-effective (7). The use of alpha-blockers before RIRS cannot cover the UAS placement difficulties.
BN was responsible for study conception. FKH wrote the manuscript.
Special thanks to the Urology Research Center (URC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Conflict of interest
All authors claim that there is no competing interest.
There was no funding.
EAU European association of urology
RIRS Retrograde intrarenal surgery
UAS Ureteral access sheaths