Abstract
ObjectivesTo compare same-sitting bilateral versus unilateral RIRS in elderly patients, focusing on postoperative complications and stone-free rates (SFR). MethodsData from two multicentre databases, FLEXOR (unilateral RIRS) and SSB-RIRS (bilateral RIRS), were analysed, considering only patients aged 70+ with preoperative CT. Patients were categorized into Group1 (bilateral RIRS) and Group2 (unilateral RIRS). Follow-up included imaging assessments and secondary treatments as needed. ResultsGroup1 included 146 patients, while Group2 had 495. Group1's patients were slightly older and had a higher prevalence of recurrent stone formation. Group2 often underwent RIRS for incidental stones. Group1 had larger and more pelvic stones. Laser lithotripsy and total operation times were significantly longer in Group1. Group2 had significantly higher overall SFR, although there were no significant differences in ancillary procedures for residual fragments. Group1 experienced more pelvicalyceal injuries needing stenting, postoperative fever, and post-op haematuria not requiring transfusion. ConclusionIn conclusion, bilateral RIRS can be carefully considered in elderly patients. Preoperative counselling is essential for both primary and repeat RIRS procedures, and further research is needed to optimize instrument and laser strategies for better outcomes in elderly RIRS patients.
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