Synchronous bilateral surgery for calculous disease of the upper urinary tract

Bilateral calculous disease of the upper urinary tract frequently poses great difficulty in therapeutic decisions. Staged or sequential surgery is often recommended, with the side that is more obstructed, infected, or symptomatic operated on first. Despite all the rationalization for sequential surgery, we believe that a simultaneous surgical approach to bilateral calculous disease is feasible and advisable in some situations. On the basis of our experience with nine patients, we have categorized the indications for such surgery. In patients, with bilateral calculous disease for whom surgical intervention on both sides will at some point be necessary, simultaneous single-stage surgery is recommended. This is especially true: (a) with bilateral obstructive calculi; (b) in bilateral calculous disease with acute pyelonephritis when which side is affected is equivocal; (c) when anatomic proximity makes bilateral surgery easier, e.g. in bilateral lower ureteral calculi or bilateral calculi in horseshoe kidneys.