title: Simultaneous bilateral retrograde intrarenal surgery for stone disease in patients with significant comorbidities.
abstract: OBJECTIVE
  Advances in endoscopic equipment have allowed urologists to access stones in virtually any location in the upper tracts. Where clinically appropriate, this approach may represent the preferred treatment option, regardless of stone size. We report the first description of simultaneous bilateral retrograde intrarenal surgery (SB-RIRS) in patients with both significant upper-tract stone burdens and comorbidities such as morbid obesity or heart disease.
  
  
  METHODS
  Between September 2003 and April 2004, three men and one woman with an average of 62 years underwent a total of seven sessions of SB-RIRS. All four patients were referred from other urologists after failing prior treatments, including shockwave lithotripsy (five sessions) and RIRS (two sessions). The average stone burden was 8.8 cm. The procedures were performed by two surgeons operating simultaneously using two sets of video/holmium laser equipment. Flexible (7.5F) ureteroscopes were used to fragment and basket stone debris without the use of ureteral access sheaths.
  
  
  RESULTS
  Three patients underwent a scheduled second-stage procedure to ensure adequate stone clearance. The average total and SB-RIRS-specific operative times were 256 and 131 minutes for the initial procedure and 235 and 95 minutes for the second-stage procedure, respectively. No major complications were noted.
  
  
  CONCLUSIONS
  Simultaneous bilateral RIRS is an appropriate treatment option for stone patients with significant comorbidities.
authors.affiliation: Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles, California, USA. chungsy@gmail.com
authors.forename: Steve Y
authors.initials: SY
authors.lastname: Chung
authors.forename: Chris H
authors.initials: CH
authors.lastname: Chon
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ng
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Fuchs
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods; D013520:Urologic Surgical Procedures / Q000379:methods*