Single-session bilateral vs. staged unilateral renal stone removal: comparative outcomes in a systematic review and meta-analysis

Abstract

Introduction: There is still controversy regarding the best approach to bilateral renal urolithiasis. Single-session bilateral (SSB) renal stone removal is considered superior due to fewer procedures and less anesthesia exposure. However, doubts persist about its effectiveness and safety compared to staged unilateral (SU) procedures, particularly concerning complications and stone-free rates (SFR). We conducted a systematic review and meta-analysis to compare outcomes of these approaches. We hypothesize that SSB procedures have similar outcomes in terms of complications and SFR with fewer interventions.

Materials and methods: A meta-analysis following Cochrane and PRISMA guidelines included studies from 2002 to 2024 comparing SSB to SU procedures. Searches were conducted in PubMed, Cochrane, and EMBASE, focusing on complication rates, SFR, operative time, and additional procedures.

Results: The search yielded 13 studies with a total of 836,414 patients, of which 7,854 were in the SSB group. The rate of severe complications (Clavien-Dindo grade ≥ 3) was not significantly different between SSB versus SU groups (RR 1.22; 95% CI 0.65-2.26; P = 0.53). Nevertheless, overall complication rates were notably higher for SSB procedures (RR 1.32; 95% CI 1.08-1.62; P = 0.007). SFR was similar between approaches (RR 0.89; 95% CI 0.74-1.07; P = 0.23). Importantly, SSB procedures resulted in significantly longer operative times (MD 27.93 minutes; 95% CI 7.78-48.07; P = 0.007) and had a significantly higher need for unplanned additional interventions (RR 1.65; 95% CI 1.44-1.89; P < 0.00001).The search yielded 13 studies with a total of 836,414 patients, of which 7,854 were in the SSB group. The rate of severe complications (Clavien-Dindo grade ≥ 3) was not significantly different between SSB versus SU groups (RR 1.22; 95% CI 0.65-2.26; P = 0.53). Nevertheless, overall complication rates were notably higher for SSB procedures (RR 1.32; 95% CI 1.08-1.62; P = 0.007). SFR was similar between approaches (RR 0.89; 95% CI 0.74-1.07; P = 0.23). Importantly, SSB procedures resulted in significantly longer operative times (MD 27.93 minutes; 95% CI 7.78-48.07; P = 0.007) and had a significantly higher need for unplanned additional interventions (RR 1.65; 95% CI 1.44-1.89; P < 0.00001).

Conclusion: SSB procedures achieve similar SFR and severe complication rates as SU procedures but involve longer operative times and higher overall complication rates. Their advantage lies in reducing planned surgical sessions, offering fewer anesthesia exposures, though this benefit is offset by an increased need for unplanned additional procedures.

Keywords: Bilateral; Meta-analysis; Nephrolithiasis; Single-session; Ureterolithiasis.