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Introduction:Patients with simultaneous bilateral ureteral calculi (SBUC) can present with acute renal failure, a urological emergency. Conventional urologic practice involves immediate upper tract drainage with subsequent definitive management. This study investigates initial presentation and need for immediate intervention in these patients.
Materials & Methods:From 3472 patients with urolithiasis over a 10-year period, 34 presented with SBUC. Records were retrospectively reviewed to identify patient characteristics on
presentation,time between diagnosis of SBUC and initial intervention and postoperative outcomes
Results:On presentation, 7 patients (20.5%) had acute renal failure, 4 (11.7%) were anuric,and 8 (23.5%) displayed significant electrolyte abnormalities, primarily acidosis (14.7%). No patients required acute dialysis. Ten(29.4 %) had signs of sepsis or serious infection. Ten (29.4%) were first time stone formers. Median time between diagnosis and intervention was 4 days (0-90). Mean stone
size was 6 mm (2-12mm). Immediate drainage was required in 13
(38.2%)patients, often due to elevated white blood count(29.4%). Fifteen (44.1%)patients underwent single stage bilateral ureteroscopy without postoperative complications. Overall, serious complications were infrequent, occurring in 5 (14.7%) patients. On postoperative follow-up, only 2 (5.8%) had persistently elevated serum creatinine above baseline. Risk factor analysis identified diabetes, cardiovascular disease, and obesity as being highly comorbid with SBUC
Conclusions:Patients with SBUC can often be managed non-emergently, suggesting that most ureteral stones are
only partially obstructing. Moreover, appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy. Finally, SBUC is more common in patients with documented stone history, suggesting the need for stone prevention