Safety, Feasibility, and Efficacy of Bilateral Synchronous Percutaneous Nephrolithotomy for Bilateral Stone Disease: Evidence from a Systematic Review

Introduction: With the evolution of endourologic technology, bilateral synchronous percutaneous nephrolithotomy (BS-PCNL) has emerged as a potentially practical intervention for patients with bilateral lithiasis. Although tradition has favored a staged approach, an increasing number of original studies have reported their experiences with the synchronous approach. Materials and Methods: A Cochrane style search was performed after development of a sensitive and predefined search strategy. Primary outcomes measured were initial and final stone-free rate (SFR), drop in hemoglobin, hospital stay, operative time, and complication rates. Additional information was collected on (but not limited to) baseline characteristics, stone complexity, number of tracts made, success rate, and transfusion rate. Results: From a total 187 studies, 11 were identified (published between 1997 and 2015), and they were included in this review. In total, 594 patients with a mean age of 46 years and a male: female ratio of 3: 1 underwent BS-PCNL procedures, the majority of which was under the prone position. In 87.1% (range: 71.4%-100%) of cases, the synchronous approach was performed as planned. Multiple access tracts were established in an average of 16.7% (4.1%-24%) renal units. Mean initial SFR and final SFR were 72.6% (49%-85%) and 92.4% (87%-96.9%), respectively, with a mean operative time of 171.1 minutes (range: 107.4-269 minutes). Mean hospital stay was 3.9 days (range: 1.25-15 days). Mean complication rate per study was 23.4% (range: 12.1%-54% per study). The majority were Clavien Grade 1 (60.9%), of which fever resolving spontaneously was the most common complication. No deaths were reported in any of the papers. Conclusion: BS-PCNL seems to be a good endourologic approach for patients with bilateral stone disease, which can render high SFRs and maintain a noninferior safety profile compared with the staged approach. This technique demands careful patient selection, counseling and should be preferably performed in endourology centers with large case volumes.