Ambulatory bilateral same‐session vs. unilateral ureteroscopy: A multicentre cohort study
Mohamed Abdelkareem, Tawiz Gul, Mohannad Natheef AbuHaweeleh, Humam Emad Rajha, Hamzah Shehadeh, Mohammed Ebrahim, Ibrahim Alnadhari, Osama Abdeljaleel, Abdullah Al‐Ansari, Khaled Al‐Rumaihi, Khalid Al Jalham, Asad Zeidan, Morshed SalahAbstract
Objective
To evaluate the safety, efficacy and feasibility of ambulatory bilateral same‐session retrograde intrarenal surgery (BSS‐RIRS) compared to unilateral RIRS, under a standardized clinical protocol.
Patients and Methods
We conducted a retrospective multicentre cohort study including 202 adult patients who underwent ambulatory bilateral same‐session RIRS (BSS‐RIRS) or unilateral RIRS between January 1 and December 31, 2024 . All included patients had complete perioperative data and postoperative non‐contrast CT imaging at 4–6 weeks. Of these, 95 underwent BSS‐RIRS and 107 underwent unilateral RIRS. Demographic, clinical and operative variables were analysed. Stone‐free status (defined as residual fragments ≤4 mm) and complication rates (within 30 days) were assessed. Multivariable logistic regression was used to adjust for potential confounders.
Results
BSS‐RIRS patients had significantly longer operative times compared to the unilateral group (106.9 vs. 87.3 minutes, p < 0.001) and were more likely to be treated with thulium lasers (73.4% vs. 54.2%, p = 0.003). Preoperative stenting was notably less common in the BSS‐RIRS group (39% vs. 65.4%, p < 0.001). Despite these differences, early complication rates remained low and statistically similar between groups (2.1% vs. 3.7%, p = 0.49), with adjusted regression analysis showing a possible non‐inferior BSS‐RIRS early complication rate (OR 0.36, p = 0.209). Overall stone‐free rates were comparable (85.3% vs. 82.3%, p = 0.56). In regression analysis, bilateral RIRS showed increased odds of stone‐free status, but this was not statistically supported (adjusted OR 1.62, 95% CI 0.64–4.10, p = 0.309). Grade A stone‐free status (0 mm residual) was significantly lower in the bilateral group (72.8% vs. 93.2%, p < 0.001).
Conclusion
Ambulatory BSS‐RIRS is a safe and effective approach for managing bilateral renal stones, offering comparable overall stone‐free rates and complication profiles to unilateral RIRS. Additionally, it provides procedural efficiency and potential cost‐effectiveness when applied in appropriately selected cases. Further studies are warranted to refine patient selection criteria and validate long‐term outcomes.