Comparison of Preoperative Alpha-Blocker Therapy Versus Placebo Before Ureterorenoscopy and Lithotripsy for Distal Ureteral Stones.

Introduction Ureteric colic caused by distal ureteral stones is a common clinical condition that often requires intervention. The American Urological Association recommends the use of alpha-blockers for stones measuring ≤10 mm, as these drugs help relax the ureteric smooth muscle and facilitate stone passage. Objectives The objective of this study was to compare the efficacy of preoperative alpha-blocker therapy versus placebo in improving the success rate and reducing complications during ureterorenoscopy (URS) for distal ureteral stones. Methodology This comparative observational study was conducted in the Department of Urology and Renal Transplantation, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from March 2022 to September 2022. A total of 88 patients aged 25-65 years with distal ureteric stones of more than one month in duration were included. Patients with a history of ureteric surgery, high-grade hydronephrosis, ureteric pathology, pregnancy, spontaneous stone passage, solitary kidney, bilateral ureteric stones, prior medical expulsive therapy, or long-term use of α-adrenergic receptor blockers for benign prostatic hyperplasia were excluded. In Group A, URS and lithotripsy were performed after two weeks of alpha-blocker therapy (silodosin 8 mg once daily), while in Group B, URS and lithotripsy were performed after two weeks without alpha-blocker therapy (placebo group). Patients who expelled stones before the procedure were excluded. Effectiveness was evaluated after one week. Results The mean age of patients in Group A was 38.23 ± 8.26 years, and in Group B it was 37.46 ± 9.97 years. The majority of the patients, 65 (73.86%), were between 25 and 45 years of age. Of the 88 patients, 53 (60.23%) were male and 35 (39.77%) were female, with a male-to-female ratio of 1.8:1. In the present study, the efficacy, defined as successful URS without ureteral dilatation and absence of complications, of URS lithotripsy with alpha-blocker therapy was 81.82%, compared with 54.55% in URS lithotripsy without alpha-blocker therapy (p = 0.006), which was statistically significant. Conclusions Preoperative alpha-blocker therapy significantly improves the success of URS and reduces complications in patients with distal ureteral stones. The use of alpha-blockers is recommended to enhance procedural outcomes and minimize the risk of complications during URS and lithotripsy. Further studies with larger sample sizes and longer follow-up periods are warranted to confirm these findings.