| Abstract: |
Same-sitting bilateral retrograde intrarenal surgery is effective for patients with bilateral stones with an acceptable rate of complications. Prestenting, high-power lasers, and avoiding large stones help achieve bilateral stone-free status. Operative time should not exceed 100 min to avoid sepsis. Bilateral kidney stones are commonly treated in staged procedures. To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. A total of 1250 patients were included. The median age was 48. 0 (36-61) yr. Of the patients, 58. 2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45. 3% and 47. 9% of the left and right kidneys, respectively. Surgery was stopped in 6. 8% of cases. The median surgical time was 75. 0 (55-90) min. Complications were transient fever (10. 7%), fever/infection needing prolonged stay (5. 5%), sepsis (2%), and blood transfusion (1. 3%). Bilateral and unilateral SFRs were 73. 0% and 17. 4%, respectively. Female (odds ratio [OR] 2. 97, 95% confidence interval [CI] 1. 18-7. 49, p = 0. 02), no antibiotic prophylaxis (OR 5. 99, 95% CI 2. 28-15. 73, p < 0. 001), kidney anomalies (OR 5. 91, 95% CI 1. 96-17. 94, p < 0. 001), surgical time ≥100 min (OR 2. 86, 95% CI 1. 12-7. 31, p = 0. 03) were factors associated with sepsis. Female (OR 1. 88, 95% CI 1. 35-2. 62, p < 0. 001), bilateral prestenting (OR 2. 16, 95% CI 1. 16-7. 66, p = 0. 04), and the use of high-power holmium:YAG laser (OR 1. 63, 95% CI 1. 14-2. 34, p < 0. 01) and thulium fiber laser (OR 2. 50, 95% CI 1. 32-4. 74, p < 0. 01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session. |
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(Universitat Autònoma de Barcelona)
