Same Session Bilateral Ureteroscopy for Multiple Stones: Results from the CROES URS Global Study
Abstract
Purpose:
This study presents a comparison of the international experience with ipsilateral and bilateral ureteroscopy for multiple, bilateral ureteral and renal stones vs single stone treatment. Patient and treatment characteristics and outcomes were compared.
Materials and Methods:
The CROES (Clinical Research Office of the Endourological Society) Ureteroscopy Global Study includes 114 centers in 32 countries. Patients undergoing bilateral ureteroscopy, ipsilateral ureteroscopy for multiple stones and ureteroscopy for a single stone were examined from January 2010 to October 2012. Intraoperative characteristics and postoperative outcomes were identified for each patient. Inverse probability weighted regression adjustment analyses were done to compare outcomes independent of differences among centers and patient characteristics.
Results:
The CROES Ureteroscopy Global Study consists of 11,885 patients. A total of 2,153 patients (18.7%) were treated for multiple stones, of whom 1,880 (87.3%) and 273 (12.7%) underwent ipsilateral and bilateral ureteroscopy, respectively. Inverse probability weighted regression adjustment models for bilateral vs ipsilateral ureteroscopy and multiple vs single stone treatments showed that patients with bilateral ureteroscopy and multiple stone treatments had lower stone-free rates, higher re-treatment rates and longer operative times compared to patients who underwent ipsilateral ureteroscopy and single stone treatment. There was no difference in complication rates among bilateral, ipsilateral and single stone ureteroscopy.
Conclusions:
This study presents a large series of patients who underwent bilateral and ipsilateral ureteroscopy. Our findings suggest a decrease in stone-free rates, increased re-treatment rates, increased operative times and longer hospital stay in patients treated for multiple stones. The treatment of multiple stones and bilateral ureteroscopy are safe compared to single stone treatment and ipsilateral ureteroscopy, respectively.
References
- 1 : Contemporary management of ureteral stones. Eur Urol2012; 61: 764. Google Scholar
- 2 : EAU guidelines on interventional treatment for urolithiasis. Eur Urol2016; 69: 475. Google Scholar
- 3 : Surgical management of stones: American Urological Association/Endourological Society guideline, part I. J Urol2016; 196: 1153. Link, Google Scholar
- 4 : The natural history of asymptomatic urolithiasis. J Urol1992; 147: 319. Link, Google Scholar
- 5 : Combined ureterorenoscopy for ureteral and renal calculi is not associated with adverse outcomes. Cent Eur J Urol2015; 68: 187. Google Scholar
- 6 : Removal of asymptomatic ipsilateral renal stones following rigid ureteroscopy for ureteral stones. J Endourol2003; 17: 397. Google Scholar
- 7 : Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones. J Endourol2009; 23: 253. Google Scholar
- 8 : Simultaneous retrograde intrarenal surgery for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal. BMC Urol2015; 15: 22. Google Scholar
- 9 : Effectiveness of flexible ureteroscopic stone removal for treating ureteral and ipsilateral renal stones: a single-center experience. Korean J Urol2013; 54: 377. Google Scholar
- 10 : Treatment of ipsilateral renal ureteral calculi by combining retroperitoneal laparoscopic surgery with tubeless mini-percutaneous nephrolithotomy. Urol Int2013; 90: 139. Google Scholar
- 11 : Single-session ureteroscopy with holmium laser lithotripsy for multiple stones. Int J Urol2012; 19: 1118. Google Scholar
- 12 : Flexible ureteroscopy and laser lithotripsy for bilateral multiple intrarenal stones: is this a valuable choice?. Urology2012; 80: 800. Google Scholar
- 13 : Is bilateral ureterorenoscopy the first choice for the treatment of bilateral ureteral stones? An updated study. Urol Int2012; 89: 412. Google Scholar
- 14 : Feasibility and safety of bilateral same-session flexible ureteroscopy (FURS) for renal and ureteral stone disease. Cent Eur J Urol2015; 68: 193. Google Scholar
- 15 : Same session bilateral ureteroscopy is safe and efficacious. J Urol2011; 185: 170. Link, Google Scholar
- 16 : The impact of retrograde intrarenal surgery for asymptomatic renal stones in patients undergoing ureteroscopy for a symptomatic ureteral stone. J Endourol2013; 27: 970. Google Scholar
- 17 : The Clinical Research Office of the Endourological Society Ureteroscopy Global Study: indications, complications, and outcomes in 11,885 patients. J Endourol2013; 28: 131. Google Scholar
- 18 : Categorization of intraoperative ureteroscopy complications using modified Satava classification system. World J Urol2014; 32: 131. Google Scholar
- 19 : Postureteroscopic lesion scale: a new management modified organ injury scale—evaluation in 435 ureteroscopic patients. J Endourol2012; 26: 1425. Google Scholar
- 20 : Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery1992; 111: 518. Google Scholar
- 21 : Classification of surgical complications. Ann Surg2004; 240: 205. Google Scholar
- 22 : Adjusted Kaplan-Meier estimator and log-rank test with inverse probability of treatment weighting for survival data. Stat Med2005; 24: 3089. Google Scholar
- 23 : Bilateral single-session retrograde intra-renal surgery: a safe option for renal stones up to 1.5 cm. Urol Ann2016; 8: 56. Google Scholar
- 24 : Bilateral single-session retrograde intrarenal surgery for the treatment of bilateral renal stones. Int Braz J Urol2013; 39: 387. Google Scholar
- 25 : Editorial comment to Single-session ureteroscopy with holmium laser lithotripsy for multiple stones. Int J Urol2012; 19: 1121. Google Scholar
- 26 : Genetic determinants of urolithiasis. Nat Rev Nephrol2012; 8: 151. Google Scholar
