الفهرس 
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Abstract
There are few literatures that assessed the value of neoadjuvant Tamulosin for the ureteroscopic management of proximal ureteral calculi in adults. In addition to that, there are only a few studies that investigated the effects of DJ ureteral stenting prior to the ureteroscopic management proximal ureteral calculi in adults.
The aim of our study is to assess and compare the feasibility, outcome, intraoperative and postoperative complications of preoperative ureteric DJ stenting before ureteroscopy versus preoperative alpha blocker (Tamsulosin) use before ureteroscopy versus direct ureteroscopy in the ureteroscopic management of proximal ureteral stones using semi-rigid ureteroscopy and pneumatic lithotripsy, and also to assess the stone free rates, success rates and the need of additional treatments after doing ureteroscopy.
Among adult patients scheduled for ureteroscopic management of unilateral upper or middle ureteral calculi using pneumatic lithotripsy and semi-rigid ureteroscopy, the use of preoperative alpha-blockers, especially Tamsulosin, or preoperative DJ ureteric stenting is safe and effective with better outcome more than direct ureteroscopy.
Preoperative use of Tamsulosin 0.4mg once daily for one week before ureteroscopy is associated with a significant reduction in the operative time and postoperative colic with an acceptable complication rate and it slightly improved the stone free rate but didn’t reach the significance level.
In addition to that, the placement of preoperative DJ ureteric stenting for two weeks before ureteroscopy significantly improved the stone free rates, URS success rates, ureteroscopic access to stone and significantly reduced the hospitalization time, the need for ureteric dilatation and auxiliary therapies. Preoperative DJ ureteric stenting reduced post-operative haematuria, fever and UTI, but it didn’t reach the significant level.
In our study, we considered ureteroscopy failure as a failure to access to stone or if there was a residual stone fragment>2mm in diameter. Also, we considered ureteroscopy success when patient became free of stones or if there was a residual stone fragment ≤2mm.
We performed a prospective comparative randomized cohort study between both approaches with a control group.
Our study compared the outcomes of Preoperative Tamsulosin use for 1 week before ureteroscopy versus preoperative ureteric stenting for 2 weeks before ureteroscopy versus direct ureteroscopy using semi-rigid ureteroscopy and pneumatic lithotripsy for management of adult patients with upper or middle ureteric stones less than 20mm in diameter. The study also compared the operative parameters, intra-operative complications, postoperative complications, stone free rates, hospital stay period and the need for auxiliary treatment after doing ureteroscopy.
A 7.5 Fr semi-rigid ureteroscope was used in all cases and the ureteric calculus was fragmented using a pneumatic lithotripter. At the end of ureteroscopy, a 6 Fr ureteral catheter was placed for an average of 1 to 3 days. In complicated cases, a DJ ureteric stent was fixed instead. All ureteroscopy steps were done under fluoroscopic guidance.
The patients were followed up at 2 weeks, 1 month and 2 months following ureteroscopy to assess postoperative parameters.
These findings offer urologists and patients moderate quality evidence of the benefit of both preoperative Tamsulosin and preoperative DJ ureteric stenting to reduce time, cost, effort and complications.
Our study was limited by small number of patients, and URS procedures were done at two different hospitals. Also flexible ureteroscopy and laser lithotripsy were not used in our study which is the gold standard treatment. However, our aim was not to determine the optimal treatment of upper or middle ureteral stones, but to evaluate the safety and efficacy of preoperative Tamsulosin or preoperative DJ ureteral stenting on the outcome of semi-rigid ureteroscopy and ureteroscopic lithotripsy using pneumatic lithotripsy as treatment options.
Further research should be done on a larger scale to evaluate the safety and outcome of preoperative DJ ureteric stenting versus preoperative Tamsulosin in order to support the results and confirm our conclusion.