Bilateral kidney stones are commonly treated in staged procedures.
To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones.
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.
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.
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, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis.
SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones.
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.
European urology open science. 2023 Apr 30*** epublish ***
Daniele Castellani, Olivier Traxer, Deepak Ragoori, Andrea Benedetto Galosi, Virgilio De Stefano, Nariman Gadzhiev, Yiloren Tanidir, Takaaki Inoue, Esteban Emiliani, Saeed Bin Hamri, Mohamed Amine Lakmichi, Chandra Mohan Vaddi, Chin Tiong Heng, Boyke Soebhali, Sumit More, Vikram Sridharan, Mehmet Ilker Gökce, Azimdjon N Tursunkulov, Arvind Ganpule, Giacomo Maria Pirola, Angelo Naselli, Cemil Aydin, Fernando Ramón de Fata Chillón, Catalina Solano Mendoza, Luigi Candela, Ben Hall Chew, Bhaskar Kumar Somani, Vineet Gauhar
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France., Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia., Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey., Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan., Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain., Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco., Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, Abdul Wahab Sjahranie Hospital, Medical Faculty Mulawarman University, Samarinda, Indonesia., Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India., Department of Urology, Sree Paduka Speciality Hospital, Thillai Nagar, India., Department of Urology, Ankara University, School of Medicine, Ankara, Turkey., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Department of Urology, Muļjibhai Patel Urological Hospital, Nadiad, Gujarat, India., Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy., Department of Urology, Hitit University, School of Medicine, Çorum, Turkey., Department of Urology, Clinica Universidad de Navarra, Madrid, Spain., Department of Urology, University of British Columbia, Vancouver, Canada., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK.