Outcome of bilateral ureteroscopic retrieval of stones in a single session

Abstract

Aim:Evaluation of bilateral ureteroscopic retrieval of stones as a single-stage procedure in terms of clearance of the stones, complications of the procedure and duration of hospital stay. A successful outcome was considered when both ureters were free of stones without any major complications.Materials and Methods:A total of 60 patients with bilateral ureteric stones were treated ureteroscopically from March 2006 to September 2009 in the department of Surgery (Urology unit). Majority of the patients were in their third and fourth decade of life with 38 males and 22 females. A single session bilateral ureteroscopic retrieval of stones was done using a 7.8 Fr semirigid ureteroscope. A 0.038-inch guide wire was used and advanced under direct vision, and monitored by C-arm X-ray image intensifier. Balloon dilatation of the intramural ureters was required in 82 renal units. The stones were either extracted directly or disintegrated into small pieces by lithotripsy (pneumatic) before extraction. Ureteric stenting was required in 39 patients. Patients were followed for a period of 3-12 months.Results:A total of 60 patients (120 renal units) with bilateral ureteric stones were treated ureteroscopically. The stone size in the treated patients was in the range 6-20 mm. The stones were radio-opaque in 47 patients and radiolucent in 13 patients. Single stone was present in all except two patients. Operative time ranged between 40 and 120 minutes. Stones were completely removed in 51 (85%) patients following single-session procedure of which 39 (76.4%) were stonefree intraoperatively and another 12 (23.5%) were cleared of the stones in 4 weeks follow-up. Six patients were stonefree unilaterally. Failed procedures were managed with repeated ureteroscopy, DJ stenting and ESWL or open ureterolithotomy. Intraoperatively false passage or minor ureteric perforations were seen in six patients. Postoperative complications included abdominal pain in 10, persistent fever in 4 and hematuria in 2 patients. No long-term complications were observed. Most of the patients were discharged in 2 days.Conclusion:Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. The results are comparable to unilateral or staged bilateral procedures.