The efficacy and safety of bilateral same-session ureteroscopy with holmium laser lithotripsy in the treatment of bilateral ureteral stones

Abstract

BACKGROUND: A staged ureteroscopic procedure is the generally preferred method in the treatment of bilateral ureteral stones due to the risk of bilateral injury. In this study we aimed to evaluate the safety and efficacy of bilateral same-session ureteroscopy (BS-URS) in terms of complications, operation time, scrum creatinine, hospital stay and stone-free rates. METHODS: A total of 75 patients who underwent BS-URS and holmium laser lithotripsy were evaluated, retrospectively. The patients were re-evaluated postoperatively after four weeks with ultrasonography, X-ray or computed tomography. Pre- and postoperative variables were analyzed. The results of BS-URS were also compared with unilateral URS cases performed in the same time period. RESULTS: BS-URS was performed in 58 men and 16 women with a mean age of 46.3 years. The mean operating time was 69 min. In patients with stone burden >= 20 mm, the mean operative time was longer. Intraoperative complications were observed in eight patients, Clavien grade I in seven, and Clavien grade IIIb in one. Early postoperative complications included fever and hematuria were seen in 10.6% of the patients. One patient underwent secondary URS for residual stone. Stone free rate after four weeks was 98.6%. Overall complication and and stone-free rates were similar in BS-URS and unilateral URS groups (P>0.05). The mean operating time was significantly longer in BS-URS patients (P=0.001). CONCLUSIONS: BS-URS is as safe and efficient procedure as unilateral ureteroscopy with high stone-free and minimal morbidity rates in the treatment of bilateral ureteral stones in appropriate patients.