Bilateral same session flexible ureterorenoscopy for endoscopic management of bilateral renal calculi is noninferior to unilateral flexible ureterorenoscopy for management of multiple unilateral renal calculi: outcomes of a prospective comparative study

Abstract

Purpose

The aim of the study was to prospectively evaluate safety and efficacy of bilateral same session ureterorenoscopy (BSS-FURS) for management of bilateral renal calculi.

Methods

A prospective comparative study was designed to compare the results of BSS-FURS with unilateral flexible ureterorenoscopy (U-FURS) for management of renal calculi between June 2003 and May 2016. A sample size of 55 patients in each arm was calculated considering a 20% increase in the incidence of complications with BSS-FURS over 15% complication rate in U-FURS (alpha = 0.05; Beta = 0.90). Patient demographics, stone burden, total operative time, postoperative creatinine level, duration of hospital stay, perioperative complications and stone free rate (SFR) were compared in both the groups. The literature pertaining to BSS-FURS was reviewed.

Results

Although the study group patients had higher overall stone burden (18.60 ± 7.70 mm vs. 13.32 ± 6.43 mm) and significantly longer operative time (48.30 ± 16.71 min vs. 32.95 ± 13.05 min; p < 0.05) as compared to the control group, the length of hospital stay, SFR (67.85% vs. 78.5%; p = 0.436) and perioperative complications were comparable in both the groups. Most patients who developed postoperative fever from both groups had struvite stones.

Conclusion

BSS-FURS is a safe and efficient procedure for the management of bilateral renal calculi in the hands of an experienced endourologist. It has comparable SFR and morbidity compared to U-FURS. Caution should be exercised in patients with struvite stones, as they are more likely to develop postoperative fever.

Keywords:

• Bilateral renal calculi
• flexible ureterorenoscopy
• complications
• retrograde intrarenal surgery
• Holmium laser lithotripsy

Ethical approval

Ethics committee approval was not necessary for this study.

Consent to participate

Every patient consented to participate in study.

Consent for publication

Every patient consented to participate in study.

Author contributions

Indraneel Banerjee: writing original draft.

Abhishek Bhat: review of literature, editing manuscript, submission and revisions.

Nicholas A Smith: manuscript editing and review of literature.

Jonathan Katz: manuscript preparation and review.

Rashmi H. Shah: resources and data curation.

Shah Hemendra Navinchandra: conceptualization, methodology, visualization, resources, statistical analysis, writing review and editing.

Disclosure statement

The authors declare no competing financial interests for this study.

Hemendra Shah received $1000 from Lumenis for mentoring urologist for HoLEP in 2019. All other authors have nothing to disclose.

Data availability statement

The raw data was lost in a laptop crash in Jan 2020. However, the tables made from same were available.