N. Imdad Ali1 , Paresh Sankhe2 , Ravishankar T.H.S.3 , Jayaprakasha Gangadharaiah4
BACKGROUND The selective alpha-blockers are widely used in the clinical treatment for ureteral stones as MET (Medical Expulsive Therapy). American Urological Association and European Association of Urology, strongly recommend that patients with ureteral stones be alpha-blockers to promote stone passage. Due to the physiological effect of alpha-blockers on the ureter, researchers hypothesized that the use of alphablockers before ureteroscopy may help during the Ureteroscopic procedures, making it easier and safer. One critical step in doing ureteroscopy is directing scope into vesicoureteral junction as most of the time its non-dilated and this is place injury and later stricture chances are high which lead to failure of treatment.3 But in literature, there is a discrepancy with this hypothesis as some studies have failed to demonstrate the benefits of technical ease and lower complication rate with alpha-blocker being used in the preoperative period. METHODS We conducted a cross sectional study in the department of urology from January 2019 to January 2020. 30 patients of ureteric calculus on alpha-blocker therapy and 30 patients of BPH on alpha-blocker ± 5 alpha reductase therapy were included for study. During URSL (Ureteroscopic Lithotripsy) we used 6 / 7.5 fr URS (Ureterorenoscope), ease of admitting URS in vesicoureteral junction noted. The need for ureteral dilator for admitting URS, presence of mucosal injury, and bleeding or false passage noted as difficulty in instrumentation. And documentation of finding done in excel. RESULTS Out of 60 patients, 24 (40 %) patients didn’t need dilatation of ureteric orifice and Ureteroscopy was done easily among which 8 (33.33 %) were BPH patient and 16 (66.66 %) were ureteric calculus patient this difference is statistically significant with p-value 0.010. 36 (60 %) patients needed dilatation of ureteric orifice to facilitate URS of which 22 (61.11 %) patients were from the BPH group and 14 (38.88 %) are ureteric calculus group. The study shows a statistically significant difference with p-value 0.029. CONCLUSIONS Our study demonstrates that alpha-blockers failed to show a statistically significant difference in relaxation of the ureteric orifice in non-ureteric calculus patients. Further large group, multi-centric studies are required to find a definitive role for alpha blockers prior to URS.
