Same Session Bilateral Ureteroscopy for Multiple Stones: Results from the CROES URS Global Study

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Ureteroscopy is a common procedure for treating ureteral and renal stones.
• Comparing outcomes for ipsilateral versus bilateral ureteroscopy, and for single versus multiple stones, is crucial for optimizing patient care.
• International data provides a robust basis for evaluating these treatment strategies.

Purpose of the Study:

• To compare international outcomes of ipsilateral and bilateral ureteroscopy for treating multiple, bilateral ureteral and renal stones versus single stone treatment.
• To analyze patient and treatment characteristics and their impact on outcomes.
• To provide evidence-based insights into the efficacy and safety of different ureteroscopy approaches.

Main Methods:

• Utilized data from the Clinical Research Office of the Endourological Society (CROES) Ureteroscopy Global Study (114 centers, 32 countries).
• Included 11,885 patients treated between January 2010 and October 2012.
• Employed inverse probability weighted regression adjustment analyses to compare outcomes, controlling for patient and center variations.

Main Results:

• Analysis of 2,153 patients with multiple stones revealed that bilateral ureteroscopy (12.7%) had lower stone-free rates, higher re-treatment rates, and longer operative times than ipsilateral ureteroscopy (87.3%).
• Compared to single stone treatment, multiple stone treatments (bilateral or ipsilateral) showed decreased stone-free rates and increased operative times.
• No significant differences in complication rates were observed across bilateral, ipsilateral, or single stone ureteroscopy procedures.

Conclusions:

• Bilateral ureteroscopy and treatment of multiple stones are associated with reduced stone-free rates, increased re-treatment rates, and longer operative times compared to ipsilateral ureteroscopy and single stone treatment, respectively.
• Despite outcome differences, bilateral ureteroscopy and multiple stone treatments are considered safe procedures.
• Findings support careful consideration of treatment strategy based on stone burden and laterality to optimize outcomes in ureteroscopy.