Is Bilateral Ureterorenoscopy the First Choice for the Treatment of Bilateral Ureteral Stones? An Updated Study

Abstract

Introduction: We analyze our recent results and discuss the advantages and disadvantages of bilateral single-session ureterorenoscopy (URS) for bilateral ureteral stones. Patients and Methods: 55 patients underwent URS with pneumatic lithotripsy (PL) for bilateral stones. 61 (55.5%), 28 (25.4%) and 21 (19.1%) stones were located in the lower, middle and upper ureter, respectively. Results: Of the 110 stones, 99 (90.0%) were fragmented in a single procedure. The stone clearance rate was 94.5% after the second session. The stone clearance rates with regard to stone location were 71.4, 89.3 and 96.7% for the upper, middle and lower ureter, respectively. An analysis of the clearance rates based on location demonstrated that lower ureteric stones were more successfully removed than upper ureteric stones (96.7 vs.71.4%, p = 0.003). Conclusion: Bilateral single-session URS with PL is a highly effective treatment modality for bilateral ureteral stones. The success rate of PL is affected by stone size and location.

Same-Session Bilateral Ureteroscopy: Safety and Outcomes

“…The stone free rates in the current study are comparable to published series on bilateral ureteroscopies, which have ranged from 85-99%, depending on imaging modality and definition of stone free state (6)(7)(8)(9)(10)(11)(12)(13)(14)., again arguing for the efficacy of same-session bilateral ureteroscopy.…”

“…The overall complication rate of bilateral ureterosocpy in the current study was 16.2%, which is consistent with prior studies. Published complication rates from prior cohort series of bilateral ureteroscopic procedures ranged from 10-29%, when accounting for traditionally accepted Clavien I-V complications (6)(7)(8)(9)(10)(11)(12)(13)(14). Of note, authors that have recorded less severe morbidity have expectedly noted much higher complication rates.…”

“…In fact, an earlier study found a 29% risk of complications of bilateral ureteroscopy, substantially higher than in staged bilateral procedures (6). More recent studies have reported lower rates of and less severe complications, but many of these series are small cohorts with various different surgical techniques (6)(7)(8)(9)(10)(11)(12)(13)(14). In order to address the concerns for short and long-term complications associated with bilateral ureteroscopy we evaluated a large cohort, performed by a single surgeon series in the modern era.…”

Simultaneous ureteroscopic lithotripsy and contralateral percutaneous nephrolithotomy for ureteral calculi combined with renal staghorn calculi

“…It might result in acute bilateral upper urinary tracts obstruction and acute renal insufficiency, and it also might lead to significant morbidity . Recently, some urologists have attempted to use same‐session procedures for the management of bilateral upper urinary tracts stones, such as simultaneous bilateral SWL, synchronous bilateral PNL and simultaneous bilateral URL …”

“…3 Recently, some urologists have attempted to use same-session procedures for the management of bilateral upper urinary tracts stones, such as simultaneous bilateral SWL, synchronous bilateral PNL and simultaneous bilateral URL. [4][5][6] According to previous guidelines, patients with ureteral calculi and contralateral renal calculi can undergo URL first for ureteral calculi and then PNL for renal calculi. Even though it has been reported that synchronous URL with contralateral PNL are safe and there is an effect in some patients, there is still a lack of adequate evidence about the feasibility of this combined, bilateral procedure.…”