A comparative meta-analysis on bilateral same-session and unilateral retrograde intrarenal surgery for kidney stones

To compare the safety and efficacy of bilateral same-session retrograde intrarenal surgery (B-RIRS) and unilateral retrograde intrarenal surgery (U-RIRS) for treating renal stones, focusing on stone-free rates (SFR), complications, retreatment rates, operative time, and hospital stay.

A systematic review was conducted following PRISMA guidelines. Seven comparative studies met the inclusion criteria. Primary outcomes included SFR and complications (minor: Clavien-Dindo I-II; major: III-V); secondary outcomes comprised retreatment rates, operative time, and hospital stay. Random-effects models were used to generate pooled odds ratios (OR) for categorical outcomes and mean differences (MD) for continuous variables. Subgroup analyses compared adult-only populations with elderly-inclusive cohorts.

A total of 1,218 patients from seven studies were analyzed. Overall, B-RIRS showed no statistically significant difference in SFR (OR 0.73; 95% CI, 0.43-1.23) compared to U-RIRS, yet subgroup analyses indicated that elderly populations tended to have lower SFR with bilateral procedures. B-RIRS was associated with higher minor (OR 2.55; 95% CI, 1.33-4.90) and major complications (OR 3.16; 95% CI, 1.38-7.24), increased retreatment needs (OR 2.46; 95% CI, 1.48-4.08), and longer operative times (MD 24.99 min; 95% CI, 17.48-32.50). Hospital stay was similar between groups.

Although B-RIRS facilitates management by reducing multiple anesthesia exposures and maintaining similar SFRs, it appears to be linked with increased complication and retreatment rates, especially in elderly or comorbidity-heavy populations. Carefully selected patients may see more comparable complications. Future randomized trials are needed to confirm these subgroup findings, standardize stone-free definitions, and refine selection criteria for bilateral same-session RIRS.