Feasibility and safety of bilateral same-session flexible ureteroscopy (FURS) for renal and ureteral stone disease

Abstract

IntroductionWith rising incidence of urolithiasis, treatment of stones (both symptomatic and asymptomatic) in multiple locations including bilateral stones can be controversial and challenging. We report our experience and treatment outcomes in patients undergoing bilateral, same-session ureterorenoscopy (BS-URS) for bilateral ureteric and/or renal calculi, and discuss the advantages and disadvantages of such procedures.Material and methodsBetween May 2012 and October 2013, 251 patients underwent ureteroscopic surgery for stone disease at our institution. Of these, 21 patients underwent 25 bilateral same-session ureterorenoscopy (BS-URS) procedures during this period. Stone-free status was defined as endoscopically stone-free or radiological fragments <2 mm.ResultsThe mean bilateral stone size was 21mm (range: 4-63 mm) with a mean operating time of 70 minutes (range 35-129 minutes). Fifteen procedures (60%) were done as day case procedures with a mean stay of 0.9 days (range 0-7 days). Of the 42 renal units treated, 80% (34/42) were stone-free after a single bilateral ureteroscopy session. A further 12% (5/42) were cleared after a re-look procedure making the overall stone free rate 92.8% (39/42). There were no major complications and 3 minor complications (2 early stent removals due to stent symptoms and 1 pyelonephritis requiring intravenous antibiotics).ConclusionsBilateral same-session ureteroscopy is a safe and effective treatment option for patients with bilateral ureteric and/or renal calculi, even with stones in multiple locations and increasing stone loads. However, as with all surgery, proper patient and equipment selection is crucial in terms of reducing complication rates and improving treatment outcomes.

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.…”

Same Session Bilateral Ureteroscopy for Multiple Stones: Results from the CROES URS Global Study

“…[5][6][7][8][9][10] As ureteroscopy is generally well tolerated and associated with a low complication rate many advocate a single session for treating bilateral stones as well. [11][12][13][14][15][16] Recent studies examining ureteroscopy for multiple ipsilateral stones (I-URS) suggest this approach to be associated with longer procedure times, higher ureteric stent placement rates, and a longer stent dwell time. 5,6,16 I-URS does not increase hospital length of stay (LOS) and when compared to URS for a single stone, similar success rates are seen with no difference in complication rates.…”

“…5,16 By treating asymptomatic renal stones during the treatment of symptomatic ureteric stones, the need for auxillary treatments may decrease along with potentially preventing future episodes of renal colic. 14 Some studies examining I-URS suggest safety and efficacy only with smaller stones. 7,9,12 Bilateral ureteroscopy for multiple stones (B-URS) is more controversial than I-URS due to potential increased risk for bilateral complications.…”