BACKGROUND: Preoperative tamsulosin use in children in improving success in primary ureteroscopy (URS) has had conflicting results. We aim to determine if preoperative tamsulosin prior to URS in unstented pediatric patients would improve success of navigating the ureterovesical junction (UVJ) during flexible or semirigid URS. We hypothesized that preoperative tamsulosin would improve success of navigation through the UVJ.
METHODS: A retrospective multi-institutional cohort study of patients aged 3-18 years who underwent successful or attempted primary URS from January 2017 through December 2023 (IRB #210447) was conducted. The exposure was administration of preoperative tamsulosin. Patients were excluded if: a ureteral stent was placed prior to URS, or if there was a history of URS within the past year, ureteral reimplant, or UVJ obstruction. Demographic, preoperative and intraoperative data were recorded, including stone size, location, and dose, duration and administration of tamsulosin. The primary outcome was success with primary URS, defined as the ability to pass a semirigid or flexible ureteroscope proximal to the UVJ. The secondary outcome was the use of additional intraoperative techniques for ureteral access. A priori power calculations were performed. Univariate and multivariable logistic regression analyses were performed, with adjustment for potential confounders.
RESULTS: 115 patients from 4 institutions were included, with 10 undergoing bilateral URS. Median age at surgery was 15 years (IQR 11-16 years), with a median BMI of 20.4 (IQR 17.8-25.4). The majority of URS were performed for nephrolithiasis (92%). There were no differences in preoperative and intraoperative characteristics between the two cohorts (Table 1). The overall success rate of primary URS was 84%. Pre-operative tamsulosin was administered for median 14 days (IQR 10-20). On univariate analysis, success of primary URS did not differ between cohorts (tamsulosin 86% vs. non-tamsulosin 83%, p=0.66); exposure to tamsulosin likewise did not affect success when only flexible URS (91 vs. 90%, p=0.86) or additional intraoperative techniques for ureteral access (coaxial dilators, balloon dilators or ureteral access sheaths) were used (43% vs. 44%, p=0.97). Adjusting for age, sex, body mass index, ureteroscope type and ureteral access techniques, tamsulosin use did not significantly improve the odds of successful primary URS (Table 2, OR 1.5, CI 0.44-5.1, p=0.51). It is possible that our sample size was not large enough to detect a significant difference between cohorts.
CONCLUSIONS: Preoperative tamsulosin was not associated with improved odds of traversing the ureteral orifice in primary flexible or semirigid URS in the unstented pediatric population.
