Flexible Ureteroscopy and Laser Lithotripsy of bilateral ureteral stones: efficacy and safety used for the treatment of urolithiasis.
Aim: To demonstrate the safety and efficacy of flexible ureteroscopy (FURS) and holmium laser lithotripsy of bilateral ureteral stones by stone cumulative >20mm.
Materials and Methods: From September 2014 to October 2015, 22 patients who had undergone bilateral single-session retrograde intrarenal surgery (RIRS) and laser lithotripsy were included in the study. The procedures were performed in the lithotomy position on an endoscopy table under general anesthesia, beginning on the side in which the stone
size was smaller. Plain abdominal radiography, renal ultrasonography (USG) and non-contrast tomography (CT) scans were conducted for all patients. The success rate was defined as patients who were stone-free or only had residual fragment less than 4 mm. We made an analytical study (uni- and multi-variate) to identify predictors of failure .
Results: A total of 30 patients ( 21 men, 09 women) with a mean age 43.7 years were included in the present study. The mean Cumulative Stone Diameter size was 28.67mm (range:12- 49mm). All patients were treated during the same operative session. With a mean operative time 129 of minutes. The stone-free rates (SFR) (Success at least one side) were 96.07% and 73.3% bilateral success. The univariate analysis showed a statistical correlation between the failure of URS and the following variables: the size of stone (p <0,001), cumulative stone diameter size (p=0,02) and number of stones (p<0,01). The multivariate logistic regression analysis retained: the cumulative stone diameter size (p = 0.02) as independent predictive factors of failure of URS. Adverse post ureteroscopy effects were frequent (moderate pelvic pain : 100%, hematuria 100 %).Their intensity was always minimal to moderate.
Complications were rare 1.9%. It was minor complications in all cases ( mucosal injury : 1 case; cracking meatus: 3 cases ) not requiring a supplementary procedure
Conclusions: Bilateral single-session RIRS and laser lithotripsy can be performed safely and effectively with a high success rate and low complication rate in patients with bilateral renal stones.