Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients.

BACKGROUND

Bilateral kidney stones are commonly treated in staged procedures.

OBJECTIVE

To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones.

DESIGN SETTING AND PARTICIPANTS

Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR.

RESULTS AND LIMITATIONS

A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49,  = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73,  < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94,  < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31,  = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62,  < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66,  = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34,  < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74,  < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis.

CONCLUSIONS

SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones.

PATIENT SUMMARY

In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.