الفهرس 
UROLITHIASISOnly 14 pages are availabe for public view
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Abstract
The incidence of pediatric urolithiasis has risen dramatically over the past few decades, with a reported rate of 4% per year.
There is controversy regarding the practice of routine balloon dilation to gain ureteral access in children, as Balloon dilation of the ureteral orifice carries the risk of ureteral perforation and ureteral stricture, due to tissue ischemia.
There are three subtypes of alpha- 1 adrenoceptors (ARs) in the ureteric wall: alpha-1A, alpha-1B and alpha-1D. In the proximal ureter, the distribution of ARs was alpha-1D ≥ alpha-1B > alpha-1A. In the distal and middle ureters, the distribution of ARs was alpha-1D > alpha-1A > alpha-1B. Tamsulosin acts on α1A and α1D receptors causing the relaxation of the ureteric wall, which consequently increases the urine bolus and intra-ureteral pressure above the stone and lowers intra-ureteral pressure below the stone by decreasing peristalsis in association with the decrease in basal and micturition pressure, even at the bladder neck; thus, it increases the chance of stone expulsion.
The management of upper ureteric stones consists of observation, shockwave lithotripsy (SWL), flexible ureteroscopy, push and percutaneous nephrolithotomy or open and laparoscopic ureterolithotomy.
The aim of this study was to evaluate efficacy adjunctive alpha-blocker therapy before flexible ureteroscopy in the management of Upper ureteric stones in children as regard facilitating ureteric orifice navigation, Ureteral Dilatation, intraoperative and postoperative Complication, patient satisfaction and stone free rate.
This was a prospective randomized control study that was conducted at Urology Department, Faculty of Medicine, Ain Shams University on 80 patients they were divided into 2 groups. group A (random): 40 Children received Tamsulosin 0.4 mg capsule for 5 days prior to Flexible uretroscopy. group B (random): 40 Children didn’t receive Tamsulosin 0.4 mg capsule prior to Flexible uretroscopy.
The results of our present study can be summarized as follows:
This current study demonstrated that adjunctive alpha-blocker therapy tamsulosin before ureteroscopy not significantly improved successful access to the stones, Intra-post operative complication and the stone-free rate at the end of week 4.
CONCLUSION
Adjunctive alpha-blocker therapy (Tamsulosin) before flexible ureteroscopy in the management of upper ureteric stone in school age children failed to show a statistically significant difference for successful ureteral orifice navigation, ureteral dilatation, stone free rete and intra-post operative complication.