Bilateral simultaneous ureteroscopy for bilateral stone disease: a systematic review

The treatment of bilateral renal and/or ureteric stones can be challenging due to concerns about its safety and efficacy compared to staged ureteroscopy. This review evaluates the current evidence to look at the outcomes of bilateral simultaneous ureteroscopy (BS-URS) for urinary stone disease.

A systematic review using studies identified by a literature search between January 1990 and August 2013. All English language articles reporting on outcomes of BS-URS for urolithiasis were included. Two reviewers independently extracted the data from each study.

A total of seven studies (312 patients) were identified with a mean age of 40 years. Of the reported stone location, two thirds of the stones were in the ureter. With a mean operative time of 58 minutes, stone free status was achieved in 87.1% after the first look and 91.6% after a re-look for pure ureteric stones. Nearly 86% of patients had a postoperative stent inserted with a mean hospital stay of 2 days. In the pure ureteric stone cohort a total of 134 (50.8%) complications were reported. Around three quarters of the complications were Clavien I grading (hematuria, lower urinary symptoms and flank pain) and under a quarter were Clavien III complications.

Although BS-URS achieved a high overall stone free rate; the complication rate seemed to be high. The quality of included studies in this review was weak and future research with good methodology is required to evaluate the feasibility and safety of BS-URS procedure.