Bilateral single-session retrograde intra-renal surgery: A safe option for renal stones up to 1.5 cm

Abstract

Introduction:Assessment of treatment outcomes in patients undergoing bilateral single-session retrograde intra-renal surgery (RIRS) for bilateral renal stones up to 1.5 cm.Materials and Methods:Retrospective analysis of 74 patients was done with bilateral renal calculi, who underwent bilateral single-session RIRS at our stone referral hospital from December 2011 to May 2014. The selection criteria for this intervention were patient's preference, failure of other treatments and stone up to 1.5 cm. Patients with creatinine more than 2, pyonephrosis sepsis, bilateral impacted pelviureteric junction calculi were excluded from study. All patients were evaluated with serum biochemistry, urinalysis, urine culture, plain radiography of kidney-ureter-bladder, intravenous urography, renal ultrasonography (USG) and/or computed tomography (CT). Follow-up evaluation included serum biochemistry and postoperative plain film and renal USG. The success rate was defined as patients who were stone-free or only had a residual fragment of less than 4 mm. CT was conducted only in patients with residual stones, which were present in seven patients.Results:A total of 74 patients (50 male, 24 female) with a mean age 39.2 ± 15.2 were included in the present study. The mean stone size was 11.7 ± 2.4 mm. The stone-free rates were 86.84% and 97.29% after the first and second procedures, respectively. In eight patients (10.8%), minor complications were observed, whereas no major complications were noted in the studied group. There was no significant difference in pre- and post-operative serum creatinine levels.Conclusion:In patients with bilateral renal stones up to 1.5 cm bilateral single-session RIRS with flexible ureteroscope can be safely performed with low complication rate.

Bilateral Simultaneous Ureteroscopic (BS-URS) Approach in the Management of Bilateral Urolithiasis Is a Safe and Effective Strategy in the Contemporary Era—Evidence from a Systematic Review

“…1 ). Six further papers were excluded upon reading the full manuscript leaving 11 papers, which were included in the study [ 11 – 21 ]. Most studies were retrospective in nature and were no randomization or control groups in these studies (see Table 1 ).…”

“…Overall six studies [ 11 , 16 , 18 – 21 ] treated bilateral renal stones, three studies treated renal stones with contralateral ureteric stones [ 11 , 19 , 20 ] and eight studies [ 11 – 15 , 17 , 19 , 20 ] treated bilateral ureteric stones (see Tables 3 and 4 ).…”

“…There was variation in how ‘stone free’ status was defined amongst included studies. Four studies defined it as fragments <4 mm [ 17 – 19 , 21 ]. Drake et al [ 20 ], Huang et al [ 16 ] and Gunlusoy et al [ 15 ] defined stone free ≤2 mm, <1 mm and no stones, respectively.…”

“…Of the two studies that reported on bilateral stent insertion the overall bilateral stent insertion rate was 71.6%. Stone-free status (SFR) All studies reported on SFR, with a mean initial and final SFR of 87 and 92% respectively [ 11 – 21 ]. The overall ureteric SFR was 94.0% and the overall renal SFR was 81.0%.…”

“…Two reviewers (RG and BS) independently identified all studies that appeared to fit the inclusion criteria [ 11 – 21 ] (see Fig. 1 ).…”