Silodosin in Retrograde Intrarenal Surgery

Ain Shams University

Status and phase: Completed; Phase 3

Conditions: Urolithiasis

Treatments: Drug: Placebo; Drug: Silodosin 8 mg

Study type: Interventional

Funder types: Other

Identifiers

NCT05921370

MS 231/2023

Details and patient eligibility

About

Selective alpha-blockers have been used for the treatment of ureteric stones as medical expulsive therapy (MET). Recently they have been successfully used in passive ureteric dilatation before semirigid ureteroscopy. This study enables us to know the role of silodosin in ureteric dilatation to facilitate ureteral access sheath placement in Retrograde Intrarenal Surgery with flexible ureteroscopy.

Full description

The ureteral access sheaths (UAS) used during Retrograde Intrarenal Surgery (RIRS) were produced for easy access to the upper urinary tract. The main advantages of UAS are providing repetitive access to the ureteral and collecting duct system, decreasing intrarenal pressure, preventing bleeding-related distortion of vision by the acceleration of liquid flow, and eventually contributing toward the protection of the flexible device.

Nevertheless, there might be certain challenges during UAS placement. There are also risks, such as ureteral injury and the occurrence of ureteral stricture in the long term. However, considering the benefit/risk balance, RIRS is routinely performed in many clinics because of the ease provided by UAS.

Some problems might occur during the placement of UAS whose diameters vary between 9.5 and 14 Fr. In cases where UAS cannot be placed, manipulations can be used, such as ureteral balloon dilatation, providing access through a rigid ureteroscope with a guide wire, or dilatation with the inner sheath of the UAS, which may vary depending on the amount of personal experience. Despite such manipulations, if UAS placement is still unsuccessful, it is always more logical to place a double-J stent, enables passive dilatation, and postpone RIRS until the second operation.

This study will examine whether intramural ureteral resistance can be reduced or not and whether UAS placement can be facilitated using silodosin or not.

Enrollment: 60 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Both sex.
• Age >18 yrs old.
• Upper ureteric stones or renal stones < 2 cm.
• Patients with normal renal anatomy.
• No history of infectious or inflammatory renal condition.

Exclusion criteria

• • < 18 years old.

  • Multiple or bilateral stones.
  • Pregnant women.
  • Ureteric strictures.
  • Urinary tract infection.
  • Coagulopathy and uncorrected bleeding disorders.
  • Refusal of the surgery and requiring stent.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups, including a placebo group

Silodosin group (the intervention group)

Experimental group

Description:

Patients will receive silodosin 8 mg one tablet per day for 7 days before their scheduled retrograde intrarenal surgery.

Treatment:

Drug: Silodosin 8 mg

Placebo group (the control group)

Placebo Comparator group

Description:

Patients will receive Placebo for 7 days before their scheduled retrograde intrarenal surgery.

Treatment:

Drug: Placebo