Geraghty Robert M, Jones Patrick, Somani Bhaskar K
Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
University of Southampton, Southampton, UK.
Curr Urol Rep. 2019 Feb 21;20(3):15. doi: 10.1007/s11934-019-0877-5.
Urolithiasis is a disease of prevalence across the world and up to a quarter of patients present with multiple stones. Most procedures carried out in this scenario are staged; however, there is a growing body of evidence to suggest bilateral simultaneous (BS) procedures are safe. We performed a systematic review to investigate and evaluate the evidence for these procedures.
A systematic review was conducted according to Cochrane and PRISMA checklist for all English-language articles from January 1996 to January 2018 using Medline, CINAHL, Scopus, EMBASE, Cochrane library, Clinicaltrials.gov and Google Scholar. All studies (a minimum of 10 patients) with bilateral simultaneous percutaneous nephrolithotomy (BS-PCNL) or bilateral simultaneous ureteroscopy (BS-URS) and ipsilateral URS with contralateral simultaneous PCNL were included. Data was extracted for patient and stone demographics, outcomes and stone-free rate (SFR) and the level of evidence (using the GRADE assessment tool). Overall, 32 studies (1966 patients) were included in the review after the identification of 302 articles in the search. This included 16 studies (1073 patients) with BS-URS, 13 studies (750 patients) with BS-PCNL and 3 studies (143 patients) with URS and simultaneous contralateral PCNL. Of these, 8 were comparative studies and compared bilateral simultaneous procedure to either a unilateral or staged comparator. The mean operating time, SFR, the Clavien I-II and the Clavien ≥ III were 75 min, 91%, 22% and 1.4% for BS-URS; 157 min, 92%, 27% and 6.4% for BS-PCNL; 151 min, 76% and 5.6% for URS with contralateral PCNL. In comparison to staged procedures, although the SFR and complication rates were similar, there was a significantly reduced operative time and hospital stay with simultaneous procedures (p < 0.001). Although evidence for bilateral simultaneous endourological procedures is limited, results from available studies show that outcomes are at least equivalent to staged procedures. Key advantages seem to be reduced operative times, cost and hospital stay which will lead to an increased uptake of these procedures in the future.
尿石症是一种在全球范围内普遍存在的疾病，多达四分之一的患者患有多发性结石。在这种情况下进行的大多数手术都是分期进行的；然而，越来越多的证据表明双侧同时（BS）手术是安全的。我们进行了一项系统综述，以调查和评估这些手术的证据。
根据Cochrane和PRISMA清单，使用Medline、CINAHL、Scopus、EMBASE、Cochrane图书馆、Clinicaltrials.gov和谷歌学术搜索，对1996年1月至2018年1月期间所有英文文章进行了系统综述。纳入所有研究（至少10例患者），包括双侧同时经皮肾镜取石术（BS-PCNL）、双侧同时输尿管镜检查（BS-URS）以及同侧输尿管镜检查联合对侧同时经皮肾镜取石术。提取患者和结石的人口统计学数据、手术结果和无石率（SFR）以及证据水平（使用GRADE评估工具）。总体而言，在搜索到的302篇文章中，有32项研究（1966例患者）被纳入综述。其中包括16项研究（1073例患者）采用BS-URS，13项研究（750例患者）采用BS-PCNL，3项研究（143例患者）采用输尿管镜检查联合对侧同时经皮肾镜取石术。其中，8项为比较研究，将双侧同时手术与单侧或分期手术对照。BS-URS的平均手术时间、SFR、Clavien I-II级和Clavien≥III级分别为75分钟、91%、22%和1.4%；BS-PCNL分别为157分钟、92%、27%和6.4%；输尿管镜检查联合对侧经皮肾镜取石术分别为151分钟、76%和5.6%。与分期手术相比，尽管SFR和并发症发生率相似，但同时手术的手术时间和住院时间显著缩短（p<0.001）。虽然双侧同时腔内泌尿外科手术的证据有限，但现有研究结果表明，其结果至少与分期手术相当。主要优点似乎是手术时间、成本和住院时间的减少，这将导致未来这些手术的采用率增加。
