Bilateral same-session flexible ureterorenoscopy for renal and/or ureteric stone disease treatment

Primary versus deferred ureteroscopy for the management of obstructive anuria secondary to ureteric urolithiasis in children: a prospective randomized study

To compare the role of primary and deferred ureteroscopy (URS) in the management of obstructive anuria secondary to ureteric urolithiasis in pediatric patients. This prospective randomized study included 120 children aged ≤ 12 years who presented with obstructive anuria secondary to ureteric urolithiasis between March 2019 and January 2021. The children were subdivided into group A, which included children who had undergone primary URS without pre-stenting, and group B, which included children who had undergone URS after ureteric stenting. All children were clinically compensated and sepsis-free. Patients with underlying urological structural abnormalities were excluded. The operative time, improvement of renal functions, stone-free rate, and complications were compared between the two groups. At the 1-month follow-up, urine analysis; kidney, ureter, and bladder radiography; and ultrasonography were performed. The patient characteristics of both groups did not show any significant difference. Primary URS had failed in ten children (16.6%) in group A. Moreover, failure of stenting was noted in six patients (11%) in group B. The mean operative time for group B was significantly lower than that for group A (p ≤ 0.001). The stone-free rate was significantly higher in group B (p ≤ 0.001). The rate of overall complications was higher in group A. Deferred URS is preferable over primary URS in the management of obstructive anuria secondary to ureteric urolithiasis". In children because of the lower need for ureteric dilatation, higher stone- free rate, shorter procedure time, and lower complication rate.

Should we treat asymptomatic concurrent contralateral renal stones? A longitudinal analysis

The objective is to explore the need for future surgery among patients treated for asymptomatic concurrent contralateral stones versus those that were not. Upon IRB approval, we retrospectively reviewed records of patients who underwent stone surgeries (SWL, URS, PCNL) from 2009 to 2018. Patients were included if they were greater than 18 years old, had a minimum follow-up of 2 years, and had pre-operative imaging. Patients were divided into three groups: bilateral surgery, ipsilateral surgery with, and without asymptomatic concurrent contralateral stones. Cox regression was used to analyze patients' need for future surgery while controlling demographic and comorbid characteristics. Of the 1666 patients included, 51.9% were men. They were 59.7 ± 15 years and had a BMI of 31.3 ± 8.2 kg/m². During the follow-up of 5.2 ± 2.2 years (range 2-11 years), patients who had bilateral surgery and patients who had ipsilateral surgery without treatment of the asymptomatic concurrent contralateral stones had no difference in the need for future surgery (41.7% vs. 43%, p = 0.585). When stratified by stone size, patients with contralateral stones > 6 mm were more likely to require future surgical treatment than those treated bilaterally (p < 0.001). Our study demonstrates that treating asymptomatic concurrent contralateral stones does not lower the need for future surgical interventions. However, asymptomatic concurrent contralateral stones > 6 mm may portend earlier need for treatment. Therefore, bilateral treatment should be considered at presentation.