Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe?

Author(s)

Danilovic, Alexandre ^[1] ; Torricelli, Fabio Cesar Miranda ^[1] ; Marchini, Giovanni Scala ^[1] ; Batagello, Carlos ^[1] ; Vicentini, Fabio Carvalho ^[1] ; Traxer, Olivier ^[2] ; Srougi, Miguel ^[1] ; Nahas, William C. ^[1] ; Mazzucchi, Eduardo ^[1]

Affiliation

^[1] Univ Sao Paulo, Hosp Clin, Dept Urol, Sch Med, Ave Dr Eneas de Carvalho Aguiar 255, 7 & Sala 7175, BR-05403000 Sao Paulo - Brazil

^[2] Sorbonne Univ, Hop Tenon, AP HP, Dept Urol, GRC n20 Lithiase Renale, Paris - France

• Document type: Journal article
• Source: JOURNAL OF ENDOUROLOGY; v. 35, n. 1 SEP 2020.
• Web of Science Citations: 1

Abstract

Introduction:The aim of this study was to prospectively compare the outcomes of bilateral same-session retrograde intrarenal surgery (BSS RIRS) with unilateral RIRS and to compare the outcomes of first with second operated kidneys in BSS RIRS. Subjects and Methods:Consecutive symptomatic adult patients with kidney stones up to 20 mm who accepted to be treated by RIRS were prospectively studied. Stone-free rate (SFR) was evaluated by non-contrast CT for each renal unit, and surgical complications were evaluated based on Clavien-Dindo classification. Results:SFR (73.9%vs76.1%,p = 0.830) and hospitalization time (14.43 +/- 18.81 hoursvs13.00 +/- 4.89 hours,p = 0.564) were similar between unilateral and BSS RIRS groups, with less consumption of disposable devices in BSS RIRS (p = 0.017). Operative time was longer in BSS RIRS (61.24 +/- 26.62 minutesvs88.65 +/- 33.19 minutes,p < 0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9%vs39.9%,p = 0.030) and more emergency room (ER) visits (11.6%vs34.8%,p = 0.026). Moreover, although both groups temporarily increased creatinine levels, it was significantly higher in bilateral RIRS (p = 0.019). First operated kidney outcomes were similar to second operated kidney outcomes of BSS RIRS. ConclusionAlthough BSS RIRS had similar SFR and consumed less disposable devices, it had a higher overall complication rate, a higher frequency of ER visits, and higher creatinine levels during follow-up than unilateral RIRS. There is no significant outcome difference between first and second operated kidneys in BSS RIRS. (AU)

• FAPESP's process: 14/05130-2 - Assessment of flexible ureteroscopy residual fragments
• Grantee: Alexandre Danilovic
• Support Opportunities: Regular Research Grants