To compare outcomes of patients undergoing SSBU to those undergoing planned staged URS for bilateral nephrolithiasis. While single session bilateral ureteroscopy (URS) (SSBU) has the advantage of one anesthetic procedure, some may pursue a staged approach due to the potential higher risk of complications and patient discomfort with two ureteral stents.
We retrospectively identified patients undergoing SSBU and planned staged URS for nephrolithiasis between December 2007 and December 2014. Preoperative characteristics, intraoperative techniques, and postoperative outcomes were compared. Stone burden was calculated as cumulative stone diameter. Residual stone fragments were defined as any stone visible on postoperative imaging.
Sixty-three patients underwent SSBU and 37 underwent planned staged URS. Both cohorts had a relatively large cumulative stone burden (30.9mm versus 32.4mm, P = 0.71). Total operative time was significantly longer for planned staged URS (139 versus 86 minutes, P < 0.0001). There were no significant differences in complications or emergency room visits between the two cohorts despite bilateral ureteral stents being placed in the majority of the SSBU cohort (73%). There were no differences in stone free rates (SFR) or the need for additional procedures.
SSBU is safe and effective with overall shorter operative times and similar SFR compared to planned staged URS. Bilateral ureteral stent placement did not increase the rate of unplanned emergency visits. For patients with bilateral nephrolithiasis, urologists should strongly consider SSBU to limit anesthetic exposure, overall operative time, and health care costs.
Urology. 2018 Sep 05 [Epub ahead of print]
Gabriel Fiscus, Tracy Marien, Teerayut Tangpaitoon, Joseph Kuebker, S Duke Herrell, Nicole L Miller
Vanderbilt University Medical Center, Nashville, TN. Electronic address: ., Vanderbilt University Medical Center, Nashville, TN. Electronic address: ., Vanderbilt University Medical Center, Nashville, TN. Electronic address: ., Vanderbilt University Medical Center, Nashville, TN. Electronic address: ., Vanderbilt University Medical Center, Nashville, TN. Electronic address: ., Vanderbilt University Medical Center, Nashville, TN. Electronic address: .