Assessment of Safety and Efficacy in Ambulatory Bilateral same-session Ureterorenoscopy: Results of a Multicenter Study

Abstract

Abstract Aim: This study aims to assess the safety and efficacy of Bilateral Same - Session Retrograde Intrarenal Surgery (BSS-RIRS) for bilateral renal stones in ambulatory care settings. Materials and Methods: We retrospectively reviewed records from January 2019 to December 2022 for 83 patients who underwent Bilateral Same-Session Retrograde Intrarenal Surgery (BS-RIRS) to manage bilateral renal stones in an ambulatory care setting. Stone clearance was assessed six to eight weeks post-operation via imaging (NCCT KUB, US, or KUB X-ray), defining stone-free status as the absence of fragments or fragments smaller than three millimeters. Results: The median stone size was 870 cubic millimeters on the right side (IQR: 452.5 – 1752.5) and 656 cubic millimeters on the left side (IQR: 496.5 – 1276.8). Of the total cohort, 56 patients (68.3%) were pre-stented. The average surgical duration was 105.70 minutes (± 35.97). The stone-free rate (SFR) was 74%, indicating successful clearance. Notably, 13 patients (15.9%) required additional procedures due to incomplete clearance. Post-operatively, the majority (95.1%) were discharged the same day. However, four patients needed extended stays: one for IV antibiotics, another for bilateral ureteric catheter removal, and two due to surgeon preference. The mean hospital stay was 10.20 hours (± 9.05). Within 30 days post-op, 9 patients (11%) visited the emergency department due to abdominal pain. Four reported hematuria, and 1 had a fever. Importantly, only one patient required hospitalization for IV antibiotics. Conclusion: In carefully selected patients, simultaneous bilateral ureterorenoscopy in ambulatory settings is a secure intervention with commendable stone-free rates. This approach offers advantages such as shorter hospitalization, minimized intervention needs, and cost-effectiveness. To achieve these outcomes, selecting patients with a total stone burden of less than 3 cm is crucial.