Introduction
Urolithiasis, urolithiasis, upper urinary tract stones, JJ, long-term ureter stricture, chronic kidney disease, stone disease, ureter injuries, ureter wall damage, renal colic, prostate, pain, ureteric injury, acute ureter damage, spasms, injuries, chronic disease
UROLITHIASIS, UROLITHIASIS, DISORDER, RECURRENCE, CONTRACTION, PROSTATE, URETER, URETERAL CALCULI, URETHRA, DILATION, BENIGN PROSTATIC HYPERPLASIA (BPH), COMPLICATIONS, CHRONIC DISEASE
Urolithiasis is a common urological disorder in the world, and it has a great effect on the global health system. The lifetime prevalence of urolithiasis is reported to be about 10%, and there is an estimated 50% recurrence of renal colic in 5 years after the first episode. It is a chronic disease with recurrent pain episodes, finally reaching the chronic kidney disease [Since 1950s, technology for stone disease has been making us use new devices and change the management algorithm for every 10 years. The therapeutic goal is to achieve the highest possible stone-free rate (SFR) while minimizing invasiveness. Percutaneous nephrolithotomy and flexible ureterorenoscopy (f-URS) are the two most commonly used minimally invasive treatments for upper urinary tract stones [The advancements in f-URS and accompanying equipment, such as the ureteral access sheath (UAS) and baskets, have greatly enhanced the benefits of f-URS procedures. These technological advancements have played a significant role in expanding the range of indications for f-URS procedures. In recent literature, it was reported that F-URS have 70–90% SFR with less complications and more tolerability [However, application of f-URS is a complex multi-step act, and it may be difficult if any of consecutive actions fails during the operation. For instance, the ureteral orifice may not lead to the entrance and advancement of UAS; urethra, external urethral sphincter, prostate, and bladder neck may cause difficulty in UAS placement; and all these factors could complicate the f-URS procedure together [The use of UAS insertion carries the risk of acute ureter damage and a higher likelihood of long-term ureter stricture. Although there is limited research on ureter injuries associated with UAS, one study reported an incidence rate of 46.5% for acute ureter wall damage. Furthermore, a significant proportion (up to 15%) of individuals with severe injuries showed involvement of the smooth muscle layer [The lower portion of the ureter contains a significant number of α-adrenergic receptors (α-ARs), which play a role in the contraction of the ureteric smooth muscle when stimulated by phenylephrine. In certain instances, maneuvering the ureteroscope toward the stone becomes challenging or even impossible after passing through the ureteric orifice. In such cases, the insertion of a JJ stent is performed to dilate the ureter, and the ureterorenoscopy (URS) procedure is rescheduled for a later session [Alpha-1 blockers, which are commonly used in the treatment of benign prostatic hyperplasia (BPH), have shown to be essential in medical expulsive therapy (MET), particularly for distal ureteral calculi. They help relax the muscles in the ureter, prevent spasms, and facilitate the dilation of the ureteral lumen [The European Association of Urology recommends α-1-blokers for distal ureteral stones. Tamsulosin and silodosin are the main alpha1-blokers used for MET [We hypothesized that using silodosin preoperatively could ease the stages of the f-URS procedure via urethral, prostatic, bladder neck, and ureteral relaxation. We aimed to assess whether preoperative administration of silodosin can facilitate the placement of ureteral access sheath (UAS) prior to flexible ureteroscopy (F-URS) and reduce the occurrence of ureteric injury in challenging cases.