Lepine Henrique L, Vicentini Fabio Carvalho, Danilovic Alexandre, Molina Wilson R, Vergamini Lucas B, Marchini Giovanni S, Torricelli Fabio C M, Batagello Carlos A, Nahas William C, Mazzucchi Eduardo
University of São Paulo School of Medicine, São Paulo, SP, Brazil.
Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
World J Urol. 2025 Jun 26;43(1):394. doi: 10.1007/s00345-025-05673-7.
To compare the safety and efficacy of bilateral same-session retrograde intrarenal surgery (B-RIRS) and unilateral retrograde intrarenal surgery (U-RIRS) for treating renal stones, focusing on stone-free rates (SFR), complications, retreatment rates, operative time, and hospital stay.
A systematic review was conducted following PRISMA guidelines. Seven comparative studies met the inclusion criteria. Primary outcomes included SFR and complications (minor: Clavien-Dindo I-II; major: III-V); secondary outcomes comprised retreatment rates, operative time, and hospital stay. Random-effects models were used to generate pooled odds ratios (OR) for categorical outcomes and mean differences (MD) for continuous variables. Subgroup analyses compared adult-only populations with elderly-inclusive cohorts.
A total of 1,218 patients from seven studies were analyzed. Overall, B-RIRS showed no statistically significant difference in SFR (OR 0.73; 95% CI, 0.43-1.23) compared to U-RIRS, yet subgroup analyses indicated that elderly populations tended to have lower SFR with bilateral procedures. B-RIRS was associated with higher minor (OR 2.55; 95% CI, 1.33-4.90) and major complications (OR 3.16; 95% CI, 1.38-7.24), increased retreatment needs (OR 2.46; 95% CI, 1.48-4.08), and longer operative times (MD 24.99 min; 95% CI, 17.48-32.50). Hospital stay was similar between groups.
Although B-RIRS facilitates management by reducing multiple anesthesia exposures and maintaining similar SFRs, it appears to be linked with increased complication and retreatment rates, especially in elderly or comorbidity-heavy populations. Carefully selected patients may see more comparable complications. Future randomized trials are needed to confirm these subgroup findings, standardize stone-free definitions, and refine selection criteria for bilateral same-session RIRS.
比较双侧同期逆行肾内手术（B-RIRS）和单侧逆行肾内手术（U-RIRS）治疗肾结石的安全性和有效性，重点关注结石清除率（SFR）、并发症、再次治疗率、手术时间和住院时间。
按照PRISMA指南进行系统评价。七项比较研究符合纳入标准。主要结局包括结石清除率和并发症（轻微：Clavien-Dindo I-II级；严重：III-V级）；次要结局包括再次治疗率、手术时间和住院时间。采用随机效应模型生成分类结局的合并比值比（OR）和连续变量的平均差值（MD）。亚组分析比较了仅包含成年人的人群和包含老年人的队列。
对七项研究中的1218例患者进行了分析。总体而言，与U-RIRS相比，B-RIRS在结石清除率方面无统计学显著差异（OR 0.73；95%CI，0.43-1.23），但亚组分析表明，老年人群双侧手术的结石清除率往往较低。B-RIRS与更高的轻微并发症（OR 2.55；95%CI，1.33-4.90）和严重并发症（OR 3.16；95%CI，1.38-7.24）、更高的再次治疗需求（OR 2.46；95%CI，1.48-4.08）以及更长的手术时间（MD 24.99分钟；95%CI，17.48-32.50）相关。两组的住院时间相似。
虽然B-RIRS通过减少多次麻醉暴露并维持相似的结石清除率来便于管理，但它似乎与并发症和再次治疗率增加有关，尤其是在老年或合并症较多的人群中。精心挑选的患者可能会有更可比的并发症。未来需要进行随机试验来证实这些亚组研究结果，规范结石清除的定义，并完善双侧同期RIRS的选择标准。
