Evaluation of Preoperative Tamsulosin Use in Ureteroscopic Holmium Laser Lithotripsy for Elderly Patients with Ureteral Stones

Summary

This study evaluated preoperative tamsulosin in elderly patients undergoing ureteroscopic holmium:YAG laser lithotripsy. Tamsulosin was associated with shorter operative time, fewer complications, reduced hospital stay, and higher stone-free rates. These findings suggest that short-course preoperative tamsulosin may serve as a safe, low-cost adjunct to optimize outcomes in geriatric ureteral stone management.

Abstract

The objective of this protocol was to evaluate perioperative clinical outcomes associated with short-course preoperative tamsulosin administration in elderly patients undergoing ureteroscopic holmium:YAG laser lithotripsy for ureteral stones. Medical records of patients aged ≥ 60 years were retrospectively reviewed. Patients were categorized into a preoperative tamsulosin group and a control group based on documented medication exposure prior to surgery. Baseline demographic and stone characteristics were comparable between groups. Comparative analysis showed that operative duration was shorter, the need for ureteral dilation was lower, postoperative inflammatory response was reduced, hospitalization was shorter, and stone-free rates at short-term follow-up were higher in the tamsulosin group. These differences were observed when comparing patients who received preoperative tamsulosin with those who did not receive α-blocker therapy. Postoperative complications occurred less frequently in the tamsulosin group, although several differences did not reach statistical significance, and no treatment-related serious adverse effects were observed. These observations indicate a potential association between preoperative tamsulosin use and improved procedural efficiency. This approach may provide a simple pharmacologic strategy to facilitate ureteroscopic access and perioperative recovery in appropriately selected elderly patients. However, due to the retrospective design, single-center setting, limited sample size, and short follow-up duration, causal relationships and long-term safety cannot be established. Prospective multicenter randomized studies are required to confirm these findings and further define the role of routine preoperative tamsulosin in geriatric ureteroscopic management.

Introduction

Urolithiasis remains one of the most common urological conditions worldwide, with a growing incidence among older adults due to increased life expectancy and evolving metabolic risk factors. In elderly patients, ureteral stones often present unique clinical challenges, including reduced physiological reserve, higher comorbidity burden, and age-related anatomical changes of the ureter¹. These factors may increase procedural complexity and the risk of perioperative complications. Therefore, optimizing minimally invasive management strategies in this population is of particular clinical importance^2,

Protocol

1. Study design and ethical approval

1. Obtain approval from the Institutional Ethics Committee before initiating the study.
   The study protocol was conducted in accordance with the ethical standards of the Institutional Ethics Committee of Jinyun County Second People’s Hospital and the principles of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of Jinyun County Second People’s Hospital (IRB approval no. JYEY20260515). The requirement for written informed consent for study participation was waived due to the retrospective nature of the study.
2. Conduct a retrospective, comparative....

Results

Baseline demographic and clinical characteristics

Baseline demographic and clinical characteristics were comparable between the two groups (Table 1). The mean age was 66.30 ± 4.20 years in Group A (tamsulosin group) and 65.90 ± 4.80 years in Group B (control group) (p = 0.620). Sex distribution was similar between groups, with male-to-female ratios of 32:20 in Group A and 34:19 in Group B (p = 0.840).

There were no.......

Discussion

The present study demonstrated comparable baseline demographic and clinical characteristics between the two groups, ensuring internal validity of outcome comparisons. Age distribution, sex ratio, comorbidity profile, and ASA physical status were similar, minimizing confounding effects. These findings align with the population-based observations of previous authors²⁸, who emphasized the importance of demographic equivalence in upper urinary tract stone management studies. Similarly, Juliebø-Jo.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Analgesics (Paracetamol/Diclofenac)	Multiple	ANL-POSTOP-24B	NSAID use per renal function and bleeding risk
Anesthesia Workstation & Drugs	Dräger / GE; hospital formulary	ANES-SET-24	ASA I–III patients only per protocol
Ceftriaxone 1 g IV	Any WHO-GMP manufacturer	CEF-1G-2409	Adjusted per culture sensitivity when needed
Double-J Ureteral Stents 4.8–6 Fr, 24–26 cm	Coloplast / Boston Scientific	DJ-26CM-24Q3	Dwell time 1–3 weeks as per protocol
Flexible Ureteroscope	Boston Scientific (LithoVue) / Olympus (URF series)	FX-URS-25-LOT01	Choice per surgeon preference and anatomy
Fluoroscopy C-Arm	Siemens / GE OEC	FL-ARM-2022	ALARA protocols followed
Holmium:YAG Laser System	Lumenis / Dornier / Quanta System	HOYAG-2024-UNIT	Settings typically 0.6–1.2 J, 8–15 Hz per protocol
Hydrophilic Guidewire 0.035"	Terumo (Glidewire) / Boston Scientific (Jagwire)	GW-HY-035-24A	Backup PTFE guidewire available
Laser Fibers 200–365 µm	Boston Scientific / Cook Medical / Quanta Fibers	LF-272-2409	Fiber tip regularly stripped and cleaved to maintain efficiency
NCCT KUB Imaging	Siemens / GE Healthcare	CT-NCCT-24	Radiation minimization per protocol
Personal Protective Equipment (PPE)	3M / Ansell	PPE-OR-24	Standard precautions
Postoperative α-blocker (optional)	Astellas / generic	TAM-POST-24	Use at clinician discretion
Semi-Rigid Ureteroscope 6/7.5 Fr	Karl Storz or Olympus	UR-2024-001	High-level disinfection/sterilization between cases per IFU
Stone Retrieval Basket 1.5–2.2 Fr	Cook N-Circle / Boston Zero Tip	RB-UR-2409	Use per fragment size and location
Tamsulosin Capsules 0.4 mg	Astellas Pharma / Any GMP-compliant manufacturer	HYP-TAM-2407A	Administered under prescription; monitor for orthostatic hypotension
Ultrasound System	Philips / GE	US-RENAL-2023	Operator-dependent; standardized protocol used
Ureteral Access Sheath 9.5/11.5 Fr and 10/12 Fr	Cook Flexor / Boston Navigator HD	UAS-1012-2408	Selected based on anatomy and need
Ureteral Balloon Dilator 12–15 Fr	Boston Scientific / Cook Medical	BAL-UR-2410	Used less frequently in tamsulosin group
Urinalysis Strips & Culture Media	Siemens Multistix / Oxoid	UA-CLT-24	Processed by hospital laboratory
Urinary Catheters (Foley) 14–16 Fr	BD / Teleflex	FOL-UR-2410	Removed when voiding adequate