Comparison of 150 simultaneous bilateral and 300 unilateral percutaneous nephrolithotomies

Purpose: To compare the results, complications, efficiency, and safety of simultaneous bilateral percutaneous nephrolithotomy (SBPN) and unilateral percutaneous nephrolithotomy (PCNL). Patients and Methods: We compared the results and complications of 150 SBPNs with those of 300 unilateral PCNLs. All the procedures were performed by one surgeon which provides relatively constant parameters. The success rates, preoperative and postoperative laboratory results, and complications were compared on the basis of stone size and the number of nephrostomy tracks. Results: There were no significant differences between the results and complications of SBPN and PCNL. The SBPN itself did not cause more blood loss than unilateral PCNL. In both groups, the blood loss was in direct proportion to the size of the stones and the number of nephrostomy tracks. After SBPN, kidney function improved >20% in 12.2% of the patients and worsened for more than 3 days in only 4%. Temporary worsening of kidney function occurred in the unilateral procedure group as well (8%), mostly in cases of solitary kidneys or bilateral stones. The SBPN was not more hazardous than unilateral PCNL (complication rate 11.3% v 14.3%, respectively). In both groups, most of the complications were in proportion to the size and difficulties of the stones. Conclusion: Simultaneous bilateral percutaneous nephrolithotomy is a safe and advantageous procedure that is not more hazardous than the separate PCNL in cases of bilateral large stone burdens. To our knowledge, these are the largest reported series of these procedures and the only comparative analysis of SBPN and PCNL.