Feasibility of single-session endoscopic combined intrarenal surgery for ipsilateral large renal stones and retrograde intrarenal surgery for contralateral renal stones: Initial experience

Objectives: To analyze the feasibility of carrying out endoscopic combined intrarenal surgery with supine miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery for patients with bilateral stones in a single session. Methods: The records of consecutive patients presenting with bilateral kidney stones who underwent endoscopic combined intrarenal surgery with miniaturized percutaneous nephrolithotomy (15-Fr miniaturized nephroscope) and retrograde intrarenal surgery on one side, and retrograde intrarenal surgery on the contralateral side were prospectively collected and analyzed. After the miniaturized percutaneous nephrolithotomy procedure, flexible uretero-renoscopy was carried out for active removal of the stone fragments. Subsequently, retrograde intrarenal surgery was carried out on the contralateral side. Results: Overall, 26 patients were included in the analysis. The stone-free rate of the initial endoscopic combined intrarenal surgery side was 76.9% (20/26), and the stone-free rate of the contralateral retrograde intrarenal surgery side was 92.3% (24/26). Complications occurred in two patients (postoperative bleeding and urinary tract infection); however, these conditions were completely resolved with appropriate medications within 2 weeks postoperatively. Univariate logistic regression analyses showed that accumulation of surgical experience (OR 117.3, P = 0.046) was a significant predictor for stone-free status. Conclusion: Carrying out endoscopic combined intrarenal surgery and contralateral retrograde intrarenal surgery in a single session for patients with bilateral stones is feasible and safe.