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Bilateral Same-Session Ureteroscopy: Safety and Efficacy
Jessica E Kreshover1, Jules Manger2, Richard K Babayan1, David S Wang1
1Boston University Medical Center, Boston, MA;2University of Virginia Health System, Charlottesville, VA

Introduction: Bilateral same-session ureteroscopy (URS) was initially avoided due to fear of increased morbidity particularly bilateral ureteral injury. However, improvements in endourologic technology and surgeon experience have minimized complications. We sought to evaluate the safety and efficacy of bilateral same-session ureteroscopy at our institution.
Materials & Methods: Retrospective chart review was conducted on all URS cases for renal and ureteral stones performed by a single surgeon from August 2003 through November 2008. Bilateral same-session cases were then isolated. Quantitative and qualitative analysis was performed.
Results: A total of 459 operative cases were identified. Of this, 86 (20%, 172 renal units) were performed as bilateral same-session ureteroscopies. There were no intraoperative complications described in any of the bilateral procedures--no ureteral perforation, episodes of lost access, or aborted cases. Seventy-eight patients (90.7%) had adequate stone clearance after one procedure and 8 (9.3%) required an additional procedure within 1 year. There were two major complications (2.3%) both being post-operative urosepsis. There were 13 (15.1%) minor complications. These included ER visits for post-operative pain and urinary tract infection without fever.
Conclusions:
To date, this is the largest series to demonstrate that bilateral ureteroscopy can be successfully performed on patients with renal and/or ureteral stones in the same session. With appropriate patient selection, bilateral same-session ureteroscopy performed by the experienced surgeon is a safe and efficacious treatment for bilateral nephrolithiasis.


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