Are adrenergic a1- antagonists beneficial for the access of retrograde ureteral access sheath or semi-rigid ureteroscope access? A systematic review and meta-analysis

Introduction: To evaluate the clinical benefit of preoperative adrenergic alpha 1-antagonist therapy in the management of upper urinary calculi.Materials and methods: Publications were searched for The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE until 1 March 2022 that related to the adrenergic alpha 1- antagonist intake as adjunctive therapy before retrograde surgery. Dichotomous data were reported with risk ratios (RR) with 95% confidence intervals (CIs) and the continuous data were reported with mean difference (MD) with 95% CIsResults: There were nine studies with 867 patients included in this meta-analysis. Preoperative adrenergic alpha 1- antagonists could significantly elevate the compared with the placebo. Higher successful access rate to the stone was found in patients who received preoperative adrenergic alpha 1- antagonists than those who received the placebo (RR 1.24; 95% CI 1.17-1.33). Besides, the application of preoperative adrenergic alpha 1- antagonists can also elevate 4th-week stone-free rate (RR 1.20; 95% CI 1.12-1.28), decrease postoperative analgesia (RR 0.30;95% CI 0.20-0.46) and result in a lower risk of overall complications (RR 0.38; 95% CI 0.24-0.61).Conclusion: Preoperative adjunctive adrenergic alpha 1- antagonist therapy is effective and safe in the management of retrograde surgery with a higher successful access rate and lower risk of severe complications.