Some criteria to attempt second side safely in planned bilateral simultaneous percutaneous nephrolithotomy

Area of Science:

• Urology
• Surgical Procedures
• Nephrolithotomy

Background:

• Bilateral simultaneous percutaneous nephrolithotomy (bsPCNL) offers efficiency but carries risks.
• Intraoperative decision-making is crucial to balance benefits and patient safety.
• Criteria for proceeding with the second side of bsPCNL require validation.

Purpose of the Study:

• To evaluate the validity of specific intraoperative criteria for deciding whether to complete a planned bilateral simultaneous percutaneous nephrolithotomy (bsPCNL).
• To compare outcomes between patients who completed bsPCNL and those who underwent single-sided PCNL due to intraoperative limitations.

Main Methods:

• Patients undergoing bilateral PCNL were monitored for operative time, hemoglobin levels, blood pressure, oxygen saturation, pH, and sodium levels.
• The procedure was halted after the first side if specific thresholds were breached.
• Success and complication rates were compared between completed bsPCNL and single-sided PCNL groups.

Main Results:

• 12 out of 42 planned bsPCNLs were stopped after the initial side, primarily due to prolonged operative time or hemoglobin decrease.
• No significant differences were observed in overall success and complication rates between the groups.
• Total hospitalization time was longer in the single-sided PCNL group, with similar rates of transfusion, infection, and urine drainage.

Conclusions:

• Intraoperative criteria can effectively guide decisions to limit bsPCNL to a single side, managing approximately 30% of cases.
• Stopping the procedure based on these criteria results in comparable outcomes to staged bilateral PCNL.
• These criteria support prioritizing patient safety during bsPCNL by potentially omitting single-session advantages when necessary.