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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

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
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

PURPOSE OF REVIEW: 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.

RECENT FINDINGS: 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.

Humans, Lasers, Solid-State, Length of Stay, Lithotripsy, Operative Time, Treatment Outcome, Ureteroscopy, Urolithiasis, Journal Article, Review
1534-6285
1-9
Geraghty, Robert M.
65977705-49f3-48b7-8a80-a86c26955755
Rai, Bhavan P.
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Geraghty, Robert M.
65977705-49f3-48b7-8a80-a86c26955755
Rai, Bhavan P.
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Geraghty, Robert M., Rai, Bhavan P., Jones, Patrick and Somani, Bhaskar K. (2017) 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. Current Urology Reports, 18 (11), 1-9. (doi:10.1007/s11934-017-0660-4).

Record type: Review

Abstract

PURPOSE OF REVIEW: 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.

RECENT FINDINGS: 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.

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10.1007%2Fs11934-017-0660-4 - Version of Record
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Accepted/In Press date: 1 April 2016
e-pub ahead of print date: 17 February 2017
Published date: February 2017
Keywords: Humans, Lasers, Solid-State, Length of Stay, Lithotripsy, Operative Time, Treatment Outcome, Ureteroscopy, Urolithiasis, Journal Article, Review

Identifiers

Local EPrints ID: 419387
URI: http://eprints.soton.ac.uk/id/eprint/419387
ISSN: 1534-6285
PURE UUID: dd312c3f-2ea8-4587-88bf-69abe1c924e8

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Date deposited: 11 Apr 2018 16:30
Last modified: 06 Oct 2020 18:20

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