Abstract  
Ureteroscopy (URS) is a common procedure for managing ureteral stones. Traditionally, pre-stenting has been utilized to facilitate ureteral dilation, reducing complications during the procedure. However, pre-stenting poses a financial burden on patients and healthcare systems and can cause discomfort. This study evaluates the efficacy of Omnic (Tamsulosin) in achieving ureteral dilation in virgin ureters before elective URS, eliminating the need for pre-stenting.  
 
   Introduction  
Pre-stenting before URS has been associated with improved surgical outcomes, including enhanced ureteral access and reduced complications (1). However, it requires an additional invasive procedure, increases healthcare costs, and contributes to patient morbidity (2). Recent studies have suggested that medical therapy, particularly α-blockers like Tamsulosin, may promote passive ureteral dilation, potentially obviating the need for pre-stenting (3). This study aims to evaluate the effect of a one-week course of Omnic (Tamsulosin) in achieving adequate ureteral dilation before elective URS in patients with virgin ureters.

Methods  
A total of 20 patients diagnosed with ureteral stones and scheduled for elective URS were included in this preliminary study. All patients had virgin ureters, defined as those without prior intervention or stenting. Participants were administered Omnic (0.4 mg Tamsulosin) once daily for one week before URS (4). No pre-stenting was performed.  
 
The primary outcome measure was the ureteral dilation status, assessed intraoperatively by the ease of ureteroscope passage (5). Secondary outcomes included operative time, complication rates, need for ureteral dilation during surgery, and cost analysis compared to pre-stenting (6). Statistical analysis was conducted to compare outcomes with historical data from patients who underwent pre-stenting before URS.

Results  
All 20 patients successfully underwent URS without the need for additional dilation procedures, suggesting adequate ureteral dilation with Tamsulosin pre-treatment (7). Ureteroscope insertion was achieved without difficulty in 18 patients (90%), while minor resistance was encountered in 2 cases (10%), which was managed conservatively (8). The mean operative time was comparable to pre-stented cases, with no significant increase in procedural duration (9).

No major intraoperative complications were reported, and postoperative outcomes were favorable, with no cases of severe hematuria or ureteral injury (10). Compared to the pre-stenting approach, Omnic therapy reduced patient burden by eliminating the need for an additional invasive procedure, reducing hospital visits, and lowering overall treatment costs (11). Cost analysis showed that pre-stenting led to an approximate additional expenditure of $500 per patient, whereas Omnic therapy added only a fraction of that cost (12).

Discussion  
The findings suggest that Omnic (Tamsulosin) may be a viable alternative to pre-stenting in facilitating ureteral dilation before URS. Tamsulosin, an α1-adrenergic receptor antagonist, induces relaxation of the ureteral smooth muscle, promoting passive dilation (13). This mechanism likely accounts for the observed success in achieving adequate ureteral access in the study cohort.  
 
Pre-stenting, while effective in improving surgical outcomes, adds to patient discomfort, increases healthcare costs, and requires an additional procedure with its associated risks (14). Our results indicate that short-term medical therapy with Tamsulosin may achieve similar benefits, reducing the need for pre-stenting in select patients (15). However, further randomized controlled trials with larger sample sizes are necessary to validate these findings and refine patient selection criteria (16).  
 
   Conclusion  
This preliminary study suggests that a one-week course of Omnic (Tamsulosin) before elective URS can effectively facilitate ureteral dilation, potentially eliminating the need for pre-stenting. This approach may offer significant advantages in reducing patient morbidity and healthcare costs. Future studies should further investigate the long-term outcomes and broader applicability of this strategy.