title: Bilateral Simultaneous Ureteroscopic (BS-URS) Approach in the Management of Bilateral Urolithiasis Is a Safe and Effective Strategy in the Contemporary Era-Evidence from a Systematic Review.
abstract: OBJECTIVE
  Ureteroscopic treatment of urolithiasis has become safer and more effective in the modern era. With a rise in the incidence of bilateral urolithiasis, management dilemma of staged single-side ureteroscopy versus bilateral simultaneous ureteroscopy (BS-URS) is often debatable. This review evaluates the current evidence base for bilateral simultaneous ureteroscopic approach in the modern era.
  
  
  RESULTS
  A systematic review was conducted from 1990 to June 2016 including all English language articles reporting on outcomes of BS-URS for urolithiasis. Data was split into two periods: period 1: 2003-2012 and period 2: 2013-2016, and analysed using SPSS version 21. A total of 11 studies (491 patients) were identified from a literature search of 148 studies with mean age of 45 years and a male: female ratio of 2:1 and a mean operative time of 69 min (SD = ±15). The initial and final stone-free rate (SFR) was 87 and 93%, respectively. Post-operative stents were placed in 89% of patients with a mean hospital stay of 1.6 days (SD = ±0.5). Overall, there was a significant negative association between case volume (procedures per month) and complication rate (p = 0.045). Mean hospital stay was significantly longer in period 1 (1.9 days, SD = ±0.5) than period 2 (1.3 days, SD = ±0.3) and complications were also significantly higher in period 1 (47%) compared to period 2 (12%) (p < 0.001). There were six studies examining holmium laser (HL) lithotripsy and three examining pneumatic lithotripsy (PL). There were significantly more complications after PL than HL; however, their SFR was similar. Our review shows that the complication rates and hospital stay are significantly reduced in the contemporary data suggesting an improving trend in outcomes following BS-URS. Simultaneous bilateral ureteroscopic treatment of urolithiasis is safe and effective in the modern era. Safety is increased in centers with increased number of procedures performed and with laser lithotripsy.
authors.affiliation: Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Geraghty
authors.affiliation: James Cook University Hospital, Middlesbrough, UK.
authors.forename: Bhavan P
authors.initials: BP
authors.lastname: Rai
authors.affiliation: Blackpool Teaching Hospital NHS Trust, Blackpool, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jones
authors.affiliation: Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK. bhaskarsomani@yahoo.com.
authors.forename: Bhaskar K
authors.initials: BK
authors.lastname: Somani
mesh_terms: D006801:Humans; D053844:Lasers, Solid-State; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods; D061646:Operative Time; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods; D052878:Urolithiasis / Q000628:therapy*
keywords: Bilateral; Calculi; Laser; Review; Simultaneous