<b>Effect of Preoperative Silodosin on Operative Time of Semi Rigid Ureteroscopy for Ureteral Stones</b>

Background: Distal ureteral stones are frequently managed with semi-rigid ureteroscopy (URS), a procedure that can be technically demanding due to ureteric smooth muscle tone and spasm. Alpha-1A adrenergic receptor blockers such as Silodosin have shown potential in facilitating ureteroscopic access by relaxing ureteral musculature, yet limited data exist on their preoperative use in surgical settings, particularly in South Asian populations. Objective: To compare the mean operative time of semi-rigid URS for distal ureteral stones between patients receiving preoperative Silodosin and those receiving a placebo. Methods: This randomized controlled trial was conducted at the Institute of Kidney Diseases, Peshawar, from December 2023 to June 2024. Sixty adult patients with single distal ureteral stones (11–20 mm) were randomly assigned to receive either Silodosin 8 mg daily or placebo for 10 days prior to URS. Operative time was measured from ureteroscope insertion to removal. Data were analyzed using independent t-tests and subgroup analyses. Results: The mean operative time was significantly lower in the Silodosin group (44.87 ± 3.34 minutes) compared to the placebo group (51.67 ± 5.35 minutes), with a mean difference of –6.80 minutes (95% CI: –9.09 to –4.51; p < 0.001). This effect remained consistent across age, gender, stone size, and laterality. Conclusion: Preoperative Silodosin significantly reduces operative time in semi-rigid URS for distal ureteral stones, suggesting a clinically valuable role in perioperative management. Further large-scale trials are warranted to validate these findings and assess broader outcomes.