Does preoperative tamsulosin improve primary access in paediatrics ureteroscopy?

Introduction Ureteroscopes are primarily designed for the adult ureter, making first-attempt passage more challenging in children. Although preoperative tamsulosin has been proposed to facilitate ureteral access in adults, its role in paediatric ureteroscopy remains uncertain, and evidence in children is limited. Establishing its potential to improve preoperative ureteral dilation and reduce procedural burden in children is therefore warranted.Objective To determine whether preoperative tamsulosin is associated with improved first-attempt ureteral access in children undergoing ureteroscopy (URS).Study Design A systematic literature search was performed up to 1 August 2025 across multiple databases to identify original research evaluating preoperative alpha-blocker use in paediatric URS. four studies meeting the inclusion criteria, all retrospective cohorts, were pooled in a meta-analysis. Heterogeneity and risk of bias were assessed.Results Across the four included retrospective studies, preoperative tamsulosin was associated with a higher likelihood of successful first-attempt ureteral access during paediatric ureteroscopy. As shown in Figure 4, the pooled analysis demonstrated an odds ratio of 2.03 (95% CI 1.31–3.15, p = 0.001), with negligible heterogeneity (I2 = 0%).Discussion The available data suggest a possible trend favouring tamsulosin for first-attempt ureteral access, although findings must be interpreted with caution due to small sample sizes, retrospective designs, and heterogeneous protocols. Effects on secondary endpoints (ureteral dilatation and stent use) were inconsistent, likely reflecting surgeon preference and differing case selection.Conclusion Preoperative tamsulosin may facilitate first-attempt ureteral access in paediatric URS, although current evidence is limited and insufficient to support routine use. Further high-quality trials are required to establish its efficacy.