Bilateral Same-Session Ureteroscopy for Treatment of Ureteral Calculi: A Systematic Review and Meta-Analysis.
BACKGROUND
The traditional procedure for the management of bilateral ureteral stones is staged ureteroscopic lithotripsy (URS). However, in recent years particularly, some urologists advocate same-session bilateral URS on the ground of success rates and minimal morbidity. This systematic review is to evaluate the efficacy and safety of same-session bilateral ureteroscopy for the treatment of ureteral calculi.


METHODS
We conducted a bibliographic search using MEDLINE (1980 to August 2015) and EMBASE (1980 to August 2015). Review articles and abstract data were excluded and only studies in English reporting on outcomes of bilateral URS were included in this meta-analysis. Two reviewers independently assessed the quality of each included studies and extracted data. STATA 12.0 was used for meta-analysis.


RESULTS
In 11 studies, 431 patients were reportedly treated with bilateral URS. Most of the stone sizes were not larger than 20 mm. The mean stone-free rate is 96% for the distal ureter, 85% for the middle ureter, and 72% for the proximal ureter. The mean operative time ranged from 45 to 100 minutes with an average hospital stay from 2 to 4 days. The overall complications rates were 17%, with the incidence of postoperative fever 4%, postoperative pain 20%, and gross hematuria 4%. Other complications, including urosepsis, urinary tract infection, small mucosal laceration, stone migration, and ureteral perforation, accounted for 6% of overall complications.


CONCLUSIONS
This meta-analysis found that bilateral same-session ureteroscopy could achieve a high overall stone-free rate. There might be a relatively higher complication incidence, but most of the complications are minor. For selected cases, bilateral URS could be safe and effective.
1 Department of Urology, Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou, China .
Hongwei
H
Ge
2 Department of Chemical Biology, Peking University School of Pharmaceutical Sciences , Beijing, China .
Xiaoqing
X
Zheng
3 Department of Urology, Peking University People's Hospital , Beijing, China .
Yanqun
Y
Na
4 School of International Studies, University of International Business and Economics , Beijing, China .
Xinzhi
X
Hou
5 Department of Urology, Peking University International Hospital , Beijing, China .
Chengfan
C
Yu
1 Department of Urology, Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou, China .
Wenting
W
Ding
1 Department of Urology, Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou, China .
Yuyong
Y
Wang
1 Department of Urology, Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou, China .
Zhijian
Z
Yu
1 Department of Urology, Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou, China .
Huadong
H
He
D000368:Aged; D005260:Female; D005334:Fever; D006417:Hematuria; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain; D061214:Patient Safety; D018805:Sepsis; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014514:Ureteral Calculi / Q000453:epidemiology / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*; D055815:Young Adult
bilateral same-session ureteroscopy; bilateral ureteral stones; complications; meta-analysis; stone-free rate; urolithiasis