To compare same-sitting bilateral versus unilateral RIRS in elderly patients, focusing on postoperative complications and stone-free rates (SFR).
Data from two multicentre databases, FLEXOR (unilateral RIRS) and SSB-RIRS (bilateral RIRS), were analysed, considering only patients aged 70+ with preoperative CT. Patients were categorized into Group1 (bilateral RIRS) and Group2 (unilateral RIRS). Follow-up included imaging assessments and secondary treatments as needed.
Group1 included 146 patients, while Group2 had 495. Group1's patients were slightly older and had a higher prevalence of recurrent stone formation. Group2 often underwent RIRS for incidental stones. Group1 had larger and more pelvic stones. Laser lithotripsy and total operation times were significantly longer in Group1. Group2 had significantly higher overall SFR, although there were no significant differences in ancillary procedures for residual fragments. Group1 experienced more pelvicalyceal injuries needing stenting, postoperative fever, and post-op haematuria not requiring transfusion.
In conclusion, bilateral RIRS can be carefully considered in elderly patients. Preoperative counselling is essential for both primary and repeat RIRS procedures, and further research is needed to optimize instrument and laser strategies for better outcomes in elderly RIRS patients.
Urology. 2024 Feb 26 [Epub ahead of print]
C Chu Ann, B Somani, D Castellani, K Y Fong, S Sarica, E Emiliani, W L K Ong, D Ragoori, M I Gökce, N Gadzhiev, Y Tanidir, M A Lakmichi, T Inoue, G M Pirola, J Y C Teoh, S B Hamri, A N Tursunkulov, A Ganpule, B H Chew, O Traxer, V Gauhar
University Malaya, Dept of Surgery Urology Unit, Kuala Lumpur, Malaysia. Electronic address: ., University Hospital Southampton NHS Foundation trust, Dept of Urology, Southampton, United Kingdom., Azienda ospedaliero universitaria Ospedali riuniti di Ancona Universita Politecnica delle Marche, Dept of Urology, Ancona, Italy., Yong Loo Lin School of Medicine National University of Singapore, Faculty of Medicine, Singapore, Singapore., Biruni University Medical School, Dept of Urology, Istanbul, Turkey., Fundacion Puigvert Autónomos University of Barcelona, Dept of Urology, Barcelona, Spain., Penang General Hospital, Dept of Urology, Penang, Malaysia., Asian Institute Of Nephrology and Urology, Dept of Urology, Hyderabad, India., Ankara University School of Medicine, Dept. of Urology, Ankara, Turkey., Saint Petersburg State University Hospital Russia, Dept of Urology, St Petersburg, Russia., Marmara University School of Medicine, Dept. of Urology, Istanbul, Turkey., University Hospital Mohammed the VIth of Marrakesh, Dept. of Urology, Marrakesh, Morocco., Hara Genitourinary Private Hospital and Kobe university, Dept. of Urology, Kobe, Japan., San Giuseppe Hospital, Dept of Urology, Milan, Italy., The Chinese University of Hong Kong, Dept. of Surgery, Hong Kong, China., King Abdullah International Medical Research Center, Dept. of Surgery, Riyadh, Saudi Arabia., AkfaMedline Hospital, Dept. of Urology, Tashkent, Uzbekistan., Muljibhai Patel Urological Hospital, Dept. of Urology, Gujarat, India., University of British Columbia, Dept. of Urology, Vancouver, Canada., Sorbonne University GRC Urolithiasis Tenon Hospital, Dept of Urology, Paris, France., Ng Teng Fong General Hospital, Dept of Urology, Singapore, Singapore.