Silodosin for Passive Ureteral Dilation Prior to Transurethral Nephrolithotripsy Using a Ureteral Access Sheath

Introduction. Urolithiasis is a common condition characterized by increased prevalence and recurrence rates. Modern treatment methods include extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy. An important aspect is reducing ureteral trauma during the placement of a ureteral access sheath in transurethral lithotripsy (TUL), which can be achieved through prestenting or alternative dilation methods, such as the use of alpha-adrenergic blockers. Objective. Investigate the effect of Silodosin administration on the success rate of ureteral access sheath placement and the risk of ureteral injury in patients without prior stent placement. Materials and Methods. The study included 70 patients with renal stones up to 20 mm in diameter. Participants were randomized into two groups: Group I received silodosin (8 mg/day for 7 days prior to surgery), and the control group received no medication. During TUL, flexible ureteroscopes, laser equipment, and ureteral access sheaths were used. The success of sheath placement and ureteral injuries was evaluated intraoperatively using the PULS scale, while postoperative outcomes were evaluated with multislice computed tomography to determine the stone-free rate (SFR). Results. Patients who received silodosin demonstrated a higher success rate with sheath placement (91.43%) compared to controls (42.86%). The SFR was also higher in the Silodosin group (71.43% vs 42.86%). The degree of ureteral injury according to the PULS scale was lower in the Silodosin group: the injuries were absent or less severe. No statistically significant differences were found between the groups on the need for stent placement. Conclusions. Preoperative administration of silodosin improves the success rate of ureteral access sheath placement, reduces risk and degree of ureteral injury in nonprestented patients. This approach shows promise in reducing complications and improving patient quality of life; however, larger studies are needed to confirm its efficacy.