Bilateral Single-Session Retrograde Intrarenal Surgery for the Treatment of Bilateral Renal Stones

Abstract

Purpose: The aim of the study was to evaluate the efficacy and safety of bilateral single--session retrograde intrarenal surgery in the treatment of bilateral renal stones. Materials and Methods: From December 2008 to February 2012, 42 patients who had undergone bilateral single-session retrograde intrarenal surgery (RIRS) and laser lithotripsy were included in the study. The procedures were performed in the lithotomy position on an endoscopy table under general anesthesia, beginning on the side in which the stone size was smaller. Plain abdominal radiography, intravenous urograms (IVU), renal ultrasonography (USG) and / or non-contrast tomography (CT) scans were conducted for all patients. The success rate was defined as patients who were stone-free or only had residual fragment less than 4 mm. Results: A total of 42 patients (28 male, 14 female) with a mean age 39.2 ± 14.2 were included in the present study. The mean stone size was 24.09 ± 6.37 mm with a mean operative time of 51.08 ± 15.22 minutes. The stone-free rates (SFR) were 92.8% and 97.6% after the first and second procedures, respectively. The average hospital stay was 1.37 ± 0.72 days. In two patients (4.7%), minor complications (Clavien I or II) were observed, whereas no major complications (Clavien III-V) or blood transfusions were noted in the studied group. Conclusions: Bilateral single-session RIRS and laser lithotripsy can be performed safely and effectively with a high success rate and low complication rate in patients with bilateral renal stones.

Safety and Efficacy of Flexible Ureteroscopy in Combination with Holmium Laser Lithotripsy for the Treatment of Bilateral Upper Urinary Tract Calculi

“…In addition, another study has obtained similar results for the comparison of simultaneous bilateral FURL, staged FURL, and unilateral FURL with no statistically significant differences in SFRs between these 3 groups [13] . In this study, the SFRs of 44 patients were 86.4% at the fourth week after the first lithotripsy and 86.4% at the second procedure, which were consistent with the results from Atis et al [27] . Moreover, we noticed that the size and location of stones can influence the effect of lithotripsy.…”

Same-Session Bilateral Retrograde Intrarenal Surgery for Upper Urinary System Stones: Safety and Efficacy

“…There have been some reports of same-session bilateral SWL, PNL, and RIRS. [4][5][6][8][9][10][11] According to American Urological Association (AUA) and European Association of Urology (EAU) guidelines, SWL is the first-line treatment for intrarenal stones < 20 mm. 12,13 Certain indications may preclude the use of SWL, however; these include pregnancy, morbid obesity, coagulopathy, and some intrinsic and extrinsic anatomic problems (e.g., patients with extremity deformity, the existence of ureteral strictures).…”

“…12 With the recent advancements in endoscopic technology, including flexible ureteroscopes (especially digital ureteroscopes), laser lithotriptors, and smaller caliber instruments (access sheaths, baskets, and laser fibers), RIRS yielded similar SFR and lower complication rates compared with PNL and higher success rates compared with SWL, and RIRS has been more popular than either of these procedures. 6 Stones anywhere in the upper urinary tract can now be reached and treated with RIRS with minimal difficulty.…”

“…Although there are several studies related to bilateral rigid ureteroscopy for patients with bilateral ureteral stones, 17,18 there are few reports in the literature about same-session RIRS for the management of bilateral UUSS. [4][5][6] Chon and associates reported bilateral RIRS for the first time in 2005. 19 There have been two major studies about bilateral RIRS for patients with bilateral UUSS.…”

“…There are few reports in the literature about same-session retrograde intrarenal surgery (RIRS) for the management of bilateral UUSS. [4][5][6] A reduction in overall operative time, anesthetic requirements, and duration of convalescence are some of the advantages of same-session bilateral RIRS; conversely, the technique exposes both ureters to injury that could lead to significant morbidity. We believe that bilateral RIRS may be a successful treatment in patients with bilateral UUSS and may demonstrate a valuable alternative to PNL and SWL in select patients.…”