Synchronous bilateral percutaneous nephrostolithotomy

Various options are available for the treatment of patients with large, bilateral renal stones, including a staged percutaneous nephrostolithotomy (PCNL), synchronous PCNL with contralateral ureterorenoscopy, and synchronous bilateral PCNL. For patients with large bilateral renal stones, a synchronous bilateral PCNL may be offered if particular criteria are met. Overall outcomes reported for synchronous bilateral PCNL include high stone-free rates (95%-97%), low complication rates (9%-12%), short length of hospital stay (4-6 days), and low blood transfusion rates. Detailed cost analysis has revealed a significant cost advantage for synchronous vs staged bilateral PCNL; however, reimbursement practices reveal a significant financial disincentive for the surgeon to perform simultaneous bilateral PCNL. Here, we review the experience and current recommendations with synchronous bilateral PCNL for the treatment of patients with large, bilateral renal calculi.