Simultaneous Bilateral Endoscopic Surgery (SBES) for Patients with Bilateral Upper Tract Urolithiasis: Technique and Outcomes

Background: The incidence of bilateral and multiple renal stones is not negligible. To date, some sparse data on simultaneous bilateral stone surgery are available in literature showing good outcomes in terms of both effectiveness and safety. Objective: To describe our series of patients with bilateral renal stones who underwent simultaneous bilateral endoscopic surgery (SBES), reporting its effectiveness and safety. Design, setting, and participants: A prospective analysis of 27 consecutive patients who underwent simultaneous flexible ureteroscopy (fURS) in one side and percutaneous nephrolithotomy (PCNL) in the other side for bilateral renal stones was performed. Surgical procedure: SBES, performing fURS in one side and PCNL in the other side contemporaneously. Measurements: Clinical data were collected in a dedicated database. Intra- and postoperative outcomes were assessed. Comparisons among pre- and postoperative serum creatinine levels and estimated glomerular filtration rate values during the study period were performed using the Kruskal-Wallis test with the Dunn multiple comparison test. Results and limitations: All the procedures were carried out until the end in both sides without encountering any complications intraoperatively. The mean stone size was 27.1 ± 8.1 and 11.1 ± 3.6 mm for the PCNL and fURS side respectively. The mean operative time was 79.4 ± 25.2 min. There were no differences in patients' creatinine and eGFR when comparing at baseline with 1-mo after SBES. No postoperative major complications were experienced (Clavien-Dindo grade I 3.7%; II 11.1%). Stone-free rate was 74% at 1-mo follow-up. The main limitation of the study is the small size of the group analyzed. Conclusions: SBES is safe and effective, with minimal morbidity. SBES has the potential advantages of shorter operative time, reduced anesthesia, and reduced hospital time, which can benefit patients, surgeons, and health care systems. Patient summary: Simultaneous bilateral endoscopic surgery is an effective treatment with low complication rates for bilateral urolithiasis. This innovative and complicated procedure should be performed in high-volume centers by experienced surgeons. In case of bilateral renal stones, simultaneous bilateral endoscopic surgery (SBES) may represent a safe and effective treatment option. SBES has the potential advantages of shorter operative time, reduced anesthesia and radiation exposure, and reduced hospital time, which can benefit patients, surgeons, and health care systems. Complete endourological armamentarium and active cooperation between surgeons and nurse team are key to success.