One Session or Two? A Meta-Analysis of Same-Session Versus Staged Bilateral Percutaneous Nephrolithotomy

Bilateral complex nephrolithiasis presents a significant surgical challenge. The standard treatment, percutaneous nephrolithotomy (PCNL), can be performed in a traditional staged approach (staged bilateral PCNL [sPCNL]) or as a bilateral same-session procedure (same-session bilateral PCNL [ssPCNL]). Although the staged method has been favored for safety, ssPCNL has emerged as a viable alternative. This meta-analysis aims to systematically compare the efficacy, safety, and efficiency of ssPCNL vs sPCNL to provide comprehensive, evidence-based insights for clinical decision-making.

A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Scopus, and Cochrane databases for comparative studies. Primary outcomes analyzed were stone-free rate (SFR), minor complications (Clavien-Dindo I-II), and hospital stay. Secondary outcomes included operative time, hemoglobin decrease, and transfusion need. Data from studies were pooled using a random-effects model for all analyses. Risk of bias was assessed with risk of bias in randomized trials and Risk of Bias in Nonrandomized Studies of Interventions.

Five studies met the inclusion criterion, comprising a total of 749 patients (308 ssPCNL, 441 sPCNL). The pooled analysis revealed no statistically significant difference between the groups in SFRs (odds ratio [OR]: 0.80 [0.47; 1.36]) or minor complications (OR: 0.88 [0.44; 1.73]). However, the ssPCNL group demonstrated a significantly shorter hospital stay (mean difference [MD] = -2.92 days; [-3.60; -2.24]; I² = 84.7%). After sensitivity analysis, ssPCNL was also associated with a reduced operative time (MD: -45.18 minutes). Transfusion needs were comparable.

ssPCNL is a safe, effective, and efficient alternative to the staged approach for managing bilateral renal stones. It offers comparable clinical outcomes while reducing patient morbidity and health care burdens associated with multiple procedures and longer hospitalizations. Thus, ssPCNL should be considered a valuable treatment option for appropriately selected patients in experienced centers.