Same-Session Bilateral Ureteroscopy: Safety and Outcomes

To assess the complications and outcomes associated with same-session bilateral ureteroscopy in a tertiary referral center, as same-session bilateral ureteroscopy for stone disease has been critiqued for the theoretical risk of injury to both ureters with subsequent risk to renal function.

We retrospectively reviewed all cases of bilateral ureteroscopy performed for urolithiasis by a single surgeon at out institution between 2009 and 2014. These were compared to a prospective unilateral ureteroscopy data base RESULTS: There were 117 same-session bilateral ureteroscopic procedures performed in 113 patients totaling 234 ureteroscopies. A flexible ureteroscope was uses in 228 ureters (97.4%), and 6 (2.6%) were semi-rigid only. Ureteral dilators were required in 8 (6.8%) cases. Pre stenting was performed in 23 patients (19.6%). Short-term complications were observed following 19 procedures (16.2%) including: 11 (9.4%) Clavien I, 4 (3.4%) Clavien II and 4 (3.4%) Clavien III. Of the 84 (71.8%) patients that completed 6 week follow up there were no long term complications. Stone free rates were 91.4% for patients imaged with KUB and US, and 84.2% for those with CT scans. . Neither complications nor re-admissions were significantly different in the unilateral group. Median length of follow up for the entire cohort was 2.8 years (range 0 - 7 years).

Bilateral ureteroscopy can be performed safely with short-term complications consistent with published literature. We found no long-term complications and high stone free rates. Bilateral ureteroscopy in a single procedure represents a viable standard of care for patients with bilateral stone disease.

Urology. 2017 Jun 23 [Epub ahead of print]

Johann P Ingimarsson, Marcelino Rivera, John J Knoedler, Amy E Krambeck

Maine Medical Center, Department of Urology, Portland, Maine and Tufts School of Medicine, Boston Massachusetts, USA. Electronic address: ., University of Indiana, Department of Urology, Indianapolis, Indiana, USA., Mayo Clinic, Department of Urology, Rochester, Minnnesota, USA.