Supplementary Material for: The Effect of Preoperative Tamsulosin on Ureteral Navigation, Operation, and Safety: A Systematic Review and Meta-Analysis

Introduction: Urolithiasis is one of the most common diseases in the world, and at present, ureteroscopy (URS) is the first choice for its treatment. Although the effect is good, there is a risk of insertion failure of ureteroscope. Tamsulosin, as an α-receptor blocker, has the function of relaxing ureteral muscles, and can help stones to be discharged from ureteral orifice. In this study, we aimed to determine the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. Methods: This study was conducted and reported according to the meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed and Embase databases were searched for studies. Data were extracted according to the PRISMA principles. We collected and combined randomized controlled trial and researches in reviews of preoperative tamsulosin to explore the effect of preoperative tamsulosin on ureteral navigation, operation, and safety. A data synthesis was performed using RevMan 5.4.1 software (Cochrane). Heterogeneity was mainly evaluated with I2 tests. Key metrics include: success rate of ureteral navigation, time of URS, stone-free rate, and postoperative symptoms. Result: We summarized and analyzed 6 studies. We noted a statistically significant improvement in the success rate of ureteral navigation (Mantel-Haenszel [M-H], odds ratio [OR]: 3.78, 95% confidence interval [CI]: [2.34, 6.12], p p = 0.02) with tamsulosin preoperatively. At the same time, we also observed that postoperative fever (M-H, OR: 0.37, 95% CI: [0.16, 0.89], p = 0.03) and postoperative analgesia (M-H, OR: 0.21, 95% CI: [0.05, 0.92], p = 0.04) were also reduced because of preoperative tamsulosin. Conclusion: Preoperative tamsulosin can not only increase the one-time success rate of ureteral navigation and the stone-free rate of URS but also reduce the incidence of postoperative adverse symptoms such as postoperative fever and postoperative pain.

引言：尿路结石症（Urolithiasis）是全球最常见的疾病之一，目前输尿管镜检查（Ureteroscopy, URS）是其首选治疗方案。尽管该疗法疗效良好，但仍存在输尿管镜置入失败的风险。坦索罗辛（Tamsulosin）作为α受体阻滞剂（α-receptor blocker），可松弛输尿管平滑肌，辅助结石从输尿管口排出。本研究旨在探讨术前使用坦索罗辛对输尿管镜导航、手术进程及手术安全性的影响。
方法：本研究按照系统评价与Meta分析首选报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）的Meta分析扩展规范进行开展与报告。通过检索PubMed及Embase数据库获取相关研究文献，并依据PRISMA原则提取研究数据。本研究纳入并合并术前使用坦索罗辛的随机对照试验及综述类研究，以探讨术前坦索罗辛对输尿管镜导航、手术进程及手术安全性的影响。采用Cochrane协作网的RevMan 5.4.1软件进行数据合成，主要通过I²检验评估研究间异质性。本研究的关键结局指标包括：输尿管镜导航成功率、URS手术时长、无结石率及术后症状。
结果：本研究共纳入并分析6项相关研究。结果显示，术前使用坦索罗辛可显著提升输尿管镜导航成功率（曼特尔-亨塞尔法（Mantel-Haenszel, M-H），比值比（Odds Ratio, OR）= 3.78，95%置信区间（95% Confidence Interval, CI）：2.34~6.12，p = 0.02），差异具有统计学意义。同时，术前使用坦索罗辛还可降低术后发热（M-H，OR = 0.37，95% CI：0.16~0.89，p = 0.03）及术后镇痛需求发生率（M-H，OR = 0.21，95% CI：0.05~0.92，p = 0.04）。
结论：术前使用坦索罗辛不仅可提升输尿管镜导航一次性成功率及URS术后无结石率，还可降低术后发热、术后疼痛等不良症状的发生率。