Prospective evaluation of Bilateral Retrograde Intrarenal Surgery: is it really safe?

Introduction The aim of this study was to prospectively compare the outcomes of bilateral same session retrograde intrarenal surgery (BSS RIRS) to unilateral RIRS and to compare the outcomes of first to second operated kidney in BSS RIRS. Methods Consecutive symptomatic adult patients with kidney stones up to 20 mm that accepted to be treated by RIRS were prospectively studied. Stone-free rate (SFR) was evaluated by non-contrast computerized tomography for each renal unit and surgical complications were evaluated based on Clavien-Dindo classification. Results SFR (73.9% vs. 76.1%, p=0.830) and hospitalization time (14.43 ± 18.81 h vs. 13.00 ± 4.89 h, p=0.564) were similar between unilateral and BSS RIRS groups with less consumption of disposable devices in BSS RIRS (p=0.017). Operative time was longer in BSS RIRS (61.24 ± 26.62 min. vs. 88.65 ± 33.19 min. P<0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9% vs. 39.9%, p=0.030) and more emergency room visits (11.6% vs. 34.8%, p=0.026). Moreover, albeit both groups temporary increased creatinine levels, it was significantly higher in bilateral RIRS (p=0.019). First operated kidney outcomes were similar to second operated kidney of BSS RIRS. Conclusion Although BSS RIRS had similar SFR and consumed less disposable devices, it had higher overall complication rate, higher frequency of emergency room visits and higher creatinine levels during follow-up than unilateral RIRS. There is no significant outcome difference between first and second operated kidney in BSS RIRS.

Journal of endourology. 2020 Jul 21 [Epub ahead of print]

Alexandre Danilovic, Fabio Torricelli, Giovanni Scala Marchini, Carlos Batagello, Fabio Carvalho Vicentini, Olivier Traxer, Miguel Srougi, William Carlos Nahas, Eduardo Mazzucchi

Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology São Paulo, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology São Paulo, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Section of Endourology, Division of Urology, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Division of Urology, Section of Endourology, Sao Paulo, São Paulo, Brazil; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Urology, Sao Paulo, São Paulo, Brazil., Hopital Tenon, 55705, GRC n 20 Lithiase Renale, AP-HP, Paris, Île-de-France, France; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Division of Urology, Sao Paulo, São Paulo, Brazil; ., University of Sao Paulo, 28133, Av Dr Eneas Aguiar 256, Sao Paulo, Brazil, 05508-900; ., Universidade de Sao Paulo Hospital das Clinicas, 117265, Division of Urology, Section of Endourology, Sao Paulo, São Paulo, Brazil; .