Bilateral Same Session Ureteroscopy in Patients with Multiple Stones: Is It a Safe and Effective Alternative?

Year 2022, Volume: 75 Issue: 2, 303 - 308, 30.06.2022

Muhammed Arif İbiş

Abstract

Objectives: The aim of our study was to evaluate the results of patients who underwent simultaneous bilateral same session ureteroscopy (BSSU)
in cases of bilateral ureteral stones.

Materials and Methods: The medical records of 721 patients who underwent ureteroscopy at our institution, between March 2014 and August 2018,
were reviewed retrospectively. BSSU was performed in 46 cases (6.4%) in total. Patient and stone characteristics, stone-free rate, and complication
rates were recorded eventually. Variables were compared between successful and unsuccessful cases.

Results: Complete stone-free was achieved in 36 (78.2%) patients after the first session and the overall SFR was 95.7% (44/46). In 18 of the patients,
at least one of the two sides had an impacted stone. The rate of stone impaction was statistically higher in unsuccessful cases (p=0.033). While
postoperative bilateral JJ stent was placed in 40 of the patients, it was unilateral in 6 patients. Complications were encountered in 6 patients in
total (13%). All of these complications were low grade, and 3 patients had fever and 3 patients had hematuria causing prolonged catheterization.
The median hospital stay of patients was 1 (1-6) day.

Conclusion: Performing BSSU in the same session in cases with bilateral ureteral stones is an effective and safe alternative with low complication
and high success rates. However, patients should be informed that the possibility of inserting a JJ catheter is higher and that additional intervention
may be required, especially in cases with impacted stones.

Keywords

Bilateral Urolithiasis , Bilateral Same Session Ureteroscopy , Multiple Ureteral Stones

Ethical Statement

Ethics Ethics Committee Approval: The approval from the Clinical Research Ethics Committee of Ankara University was obtained (approval number: 2021/241, date: 27.07.2021). Informed Consent: Informed consent was not obtained owing to the retrospective nature of the study. Peer-reviewed: Externally peer-reviewed.

Birden Fazla Taşı Olan Hastalarda İki Taraflı Aynı Seans Üreteroskopi: Güvenli ve Etkili Bir Alternatif midir?

Abstract

Amaç: Çalışmamızın amacı, bilateral üreter taşı olgularında eş zamanlı bilateral aynı seans üreteroskopi (BSSU) yapılan hastaların sonuçlarını
değerlendirmektir.

Gereç ve Yöntem: Mart 2014-Ağustos 2018 tarihleri arasında kurumumuzda üreteroskopi yapılan 721 hastanın verileri retrospektif olarak incelendi.
Toplam 46 olguya (%6,4) BSSU uygulandığı görüldü. Hasta ve taş özellikleri, taşsızlık oranı ve komplikasyon oranları kaydedildi. Değişkenler taşsızlık
sağlanan ve sağlanamayan hasta grupları arasında karşılaştırıldı.

Bulgular: Otuz altı (%78,2) hastada ilk seanstan sonra tam taşsızlık sağlandı ve toplam taşsızlık oranı %95,7 (44/46) idi. Hastaların 18’inde en az
bir tarafında empakte taş vardı. Başarısız olgularda empakte taş oranı istatistiksel olarak daha yüksekti (p=0,033). Hastaların 40’ına postoperatif
bilateral JJ stent yerleştirilirken, 6 hastada JJ stent tek taraflı yerleştirildi. Toplamda 6 (%13) hastada komplikasyonlar görüldü. Bu komplikasyonların
tümü düşük dereceli olup, 3 hastada ateş, 3 hastada kateterizasyonun uzamasına neden olan hematüri vardı. Hastaların ortanca hastanede kalış
süresi 1 (1-6) gündü.

Sonuç: Bilateral üreter taşı olan olgularda aynı seansta bilateral üreteroskopi yapılması düşük komplikasyon ve yüksek başarı oranları ile etkili ve
güvenli bir alternatiftir. Ancak JJ kateteri yerleştirme olasılığının daha yüksek olduğu ve özellikle empakte taş olgularında ek müdahale gerekebileceği
konusunda hastalar bilgilendirilmelidir.

Keywords

Bilateral Ürolitiyazis , Bilateral Aynı Seansta Üreteroskopi , Çoklu Üreter Taşı

Ethical Statement

Ethics Ethics Committee Approval: The approval from the Clinical Research Ethics Committee of Ankara University was obtained (approval number: 2021/241, date: 27.07.2021). Informed Consent: Informed consent was not obtained owing to the retrospective nature of the study. Peer-reviewed: Externally peer-reviewed.

References

• 1. Geraghty RM, Jones P, Somani BK. Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol. 2017;31:547-556
• 2. Young HH, McKay RW. Congenital valve obstruction of the prostatic urethra: RR Donnelley; 1929.
• 3. Su LM, Sosa RE. Ureteroscopy and retrograde ureteral access. Campbell’s urology, 8th ed. Philadelphia: Saunders, 2002. p. 3306-19.
• 4. Wu CF, Shee JJ, Lin WY, et al. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol. 2004;172:1899-1902.
• 5. Boyce CJ, Pickhardt PJ, Lawrence EM, et al. Prevalence of urolithiasis in asymptomatic adults: objective determination using low dose noncontrast computerized tomography. J Urol. 2010;183:1017-1021.
• 6. Ge H, Zheng X, Na Y, et al. Bilateral same-session ureteroscopy for treatment of ureteral calculi: a systematic review and meta-analysis. J Endourol. 2016;30:1169-1179.
• 7. Camilleri JC, Schwalb DM, Eshghi M. Bilateral same session ureteroscopy. J Urol. 1994;152:49-52.
• 8. Geraghty R, Abourmarzouk O, Rai B, et al. Evidence for ureterorenoscopy and laser fragmentation (URSL) for large renal stones in the modern era. Curr Urol Rep. 2015;16:54.
• 9. Somani BK, Giusti G, Sun Y, et al. Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol. 2017;35:675-681.
• 10. Hollenbeck BK, Schuster TG, Faerber GJ, et al. Safety and efficacy of samesession bilateral ureteroscopy. J Endourol. 2003;17:881-885.
• 11. Geraghty RM, Rai BP, Jones P, et al. Bilateral Simultaneous Ureteroscopic (BS-URS) Approach in the Management of Bilateral Urolithiasis Is a Safe and Effective Strategy in the Contemporary Era-Evidence from a Systematic Review. Curr Urol Rep. 2017;18:11.
• 12. El-Nahas AR, El-Tabey NA, Eraky I, et al. Semirigid ureteroscopy for ureteral stones: a multivariate analysis of unfavorable results. J Urol. 2009;181:1158- 1162.
• 13. Pace KT, Kroczak T, Wijnstok NJ, et al. Same session bilateral ureteroscopy for multiple stones: results from the CROES URS global study. J Urol. 2017;198:130-137.
• 14. Geraghty RM, Jones P, Somani BK. Simultaneous bilateral endoscopic surgery (SBES) for bilateral urolithiasis: the future? Evidence from a systematic review. Curr Urol Rep. 2019;20:15.
• 15. Legemate JD, Wijnstok NJ, Matsuda T, et al. Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones. World J Urol. 2017;35:1497-1506.
• 16. El-Hefnawy AS, El-Nahas AR, El-Tabey NA, Shoma AM, et al. Bilateral samesession ureteroscopy for treatment of ureteral calculi: critical analysis of risk factors. Scand J Urol Nephrol. 2011;45:97-101