WCE 2019: Bilateral Simultaneous Procedures for Bilateral Urolithiasis: The Future? Evidence from a Systematic Review

Abu Dhabi, United Arab Emirates (UroToday.com) In this presentation, Dr. Robert Geraghty described the use of simultaneous procedures bilaterally for patients with bilateral urolithiasis. These procedures are most commonly done in a staged manner, one side at a time. This is believed to be the safest approach to patients with bilateral urolithiasis. In this study, they aimed to determine if bilateral procedures simultaneously are in fact safe.

This was done through a systematic review of the evidence. 365 articles were identified, 264 of which were excluded by the title and 56 of which were excluded by the abstract being unrelated. 32 articles were included, 16 of which were about ureteroscopies, 13 of which were percutaneous nephrolithotomies, and 3 of which were both. In these studies, there were a total of 1966 patients who had bilateral procedures simultaneously. For URS, the average operative time in these patients was 75.4 minutes, stone free rate was 91%, and complication rate was 22%. The hospital stay was an average of 1.6 days. For PCNL, mean operative time was 157 minutes, mean stone free rate was 92%, mean complication rates were 27%, and hospital stay was 4.9 days. For both PCNL and URS, time was 151 minutes, stone free rate was 76%, and complication rates were 6%.

Based on these numbers, it is not clear whether bilateral simultaneous procedures are safe or not. It was discussed that the next step would be a randomized controlled trial directly comparing staged procedures and simultaneous procedures.

Presented by: Robert Geraghty, BMBS, BMedSci (Hons), BSc (Hons), Department of Urology, University Hospital Southampton

Written by: Rajiv Karani (Department of Urology, University of California, Irvine) at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates