Effect Of α Receptor Blockers On Ureteral Access Sheath Placement During Flexible Ureteroscopic Lithotripsy:A Meta-analysis

Objective:Through systematic review and meta-analysis,to evaluate the role of α receptor blockers in the process of sheath implantation before surgery.Methods:Systematic literature search was carried out to find related clinical studies for review.The main results of the study were the success rate of UAS implantation;Secondary outcomes were ureteral injury and postoperative stone free rate(SFR).Results:A total of 8 studies with 899 patients were included after screening.Analysis showed that the success rate of implantation was higher in the α-blocker group than in the control group(RR=1.08,95%CI 1.04-1.13,P=0.0005).In subgroup analysis,Tamsulosin and silodosin had similar effects during sheath placement(P=0.76),but there was no statistical difference between the two drugs and control group(RR=1.13,95%CI0.88-1.45,P=0.35;RR=1.10,95%CI 0.99～1.22,P=0.07).Ureteral injuries of grade ≥0were similar between the two groups(RR=0.99,95%CI 0.86-1.13;I~2=61%;P=0.85);Grade ≥1 ureteral injury was lower in the experimental group(RR=0.64,95%CI 0.44～0.93;I~2=0%;P=0.02);≥ grade 2 ureteral injury was similar between the two groups(RR=0.47,95%CI 0.20-1.09;I ^ 2 =40%;P=0.08).Postoperative SFR was similar between the two groups(RR=1.04,95%CI 0.93-1.17;I~2=0%,P=0.47).Conclusion:Preoperative application of α receptor blockers can improve the success rate of UAS implantation and is associated with lower grade of ureteral injury.The effect of Tamsulosin and silodosin in the process of sheath placement is similar.The two groups had similar postoperative SFR.