title: Safety and efficacy of synchronous percutaneous nephrostolithotomy and contralateral ureterorenoscopy for bilateral calculi.
abstract: Herein we describe the technique and review the medical records of 26 patients who underwent percutaneous nephrostolithotomy (PCNL) and simultaneous contralateral retrograde ureterorenoscopy (URS) for bilateral urolithiasis of discordant sizes at our institution. Preoperative factors, operative time, change in hemoglobin, change in serum creatinine, stone free, and efficacy rates after a single procedure were analyzed retrospectively. The total efficacy rate--defined as residual calculus of 4 mm or less--was 92.3%. A second look PCNL or URS was used to target any residual calculi; 5 of the 26 (19%) patients required further therapy following the initial intervention. All cases that required a second look were ultimately rendered stone-free. No preoperative factor was statistically significant with respect to treatment failures. In terms of complications, temporary, acute renal insufficiency occurred in 2 patients, (7.7%) and the duration was transient. Performing synchronous PCNL and contralateral retrograde URS is efficient, safe, and not more dramatically lengthy in terms of operative time or morbid in terms of complications when compared to a traditional unilateral percutaneous procedure. In this approach, management of bilateral urolithiasis in one operative procedure is practical and efficacious. The approach allows patients to return to normal activity within the same time period as those having a unilateral approach and to be free of stone without a need for a second, staged procedure.
authors.affiliation: Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
authors.forename: Barry M
authors.initials: BM
authors.lastname: Mason
authors.forename: Philip T
authors.initials: PT
authors.lastname: Koi
authors.forename: Jason
authors.initials: J
authors.lastname: Hafron
authors.forename: Paul
authors.initials: P
authors.lastname: Milhoua
authors.forename: David M
authors.initials: DM
authors.lastname: Hoenig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D018666:Ureteroscopy
chemical_list: D006454:Hemoglobins; D003404:Creatinine