Safety and efficacy of same-session bilateral ureteroscopy.
OBJECTIVE
Same-session ureteroscopy for bilateral urinary calculi would potentially reduce costs and the need for a second anesthetic compared with staged procedures. We sought to establish the safety and efficacy of same-session bilateral ureteroscopy relative to procedures for staged bilateral and multiple unilateral calculi in the context of contemporary instrumentation.


METHODS
A series of 626 consecutive patients underwent ureteroscopy for calculi between January 1997 and August 2001. Among these, 34 patients with bilateral calculi (11 staged and 23 treated in one sitting) and 54 patients with multiple unilateral calculi in distinct locations were included in this study. Multivariable regression was used to determine the association of patient-specific and technical factors with postoperative morbidity.


RESULTS
Stone-free rates were similar in the two groups and ranged from 50% to 100% depending on stone location. Postoperative complications occurred in 6 (11%) and 3 (14%) of the patients treated for multiple unilateral and for bilateral calculi in a staged procedure, respectively, compared with 7 (29%) of those undergoing same-session bilateral ureteroscopy (P = 0.12). Logistic regression revealed that same-session bilateral ureteroscopy (odds ratio [OR] 4.0; P = 0.02) and absence of a postoperative stent (OR 1.7; P = 0.03) were associated with added morbidity. However, the cumulative risk of performing staged bilateral procedures (14% per procedure) approximated that of bilateral ureteroscopy in one sitting (29%).


CONCLUSIONS
Bilateral ureteroscopy carries an increased risk of postoperative morbidity. The risk is proportional to the number of renal units treated and may be assumed at once (e.g., same-session) or over time (e.g., staged) as it applies to patients requiring bilateral ureteroscopy.
Hollenbeck
Brent K
BK
Department of Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
Schuster
Timothy G
TG
Faerber
Gary J
GJ
Wolf
J Stuart
JS
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012449:Safety; D012680:Sensitivity and Specificity; D014514:Ureteral Calculi / Q000175:diagnosis* / Q000601:surgery; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*