Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients.

Background: Bilateral kidney stones are commonly treated in staged procedures.

Objective: To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones.

Design Setting And Participants: 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.

Outcome Measurements And Statistical Analysis: 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.

Results And Limitations: 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,  = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73,  < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94,  < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31,  = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62,  < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66,  = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34,  < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74,  < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis.

Conclusions: SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones.

Patient Summary: 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.