The efficacy and safety of bilateral single-session ureteroscopy for bilateral urolithiasis: A systematic review

Objective: This systematic review aimed to evaluate the efficacy and safety of bilateral single-session ureteroscopy (BSS-URS) in treating bilateral urolithiasis, focusing on the primary outcomes such as stone-free rate (SFR), complication rate, operative time, and hospital stay. Methods: A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases identified 18 studies comprising 2904 patients. Data on patient demographics, procedural outcomes, and complications were extracted and analyzed. The Newcastle-Ottawa Scale assessed the risk of bias. Statistical analysis was performed with RStudio (version 4.5.0). Results: The mean overall SFR for BSS-URS was 84% (95% CI 79%-89%), with initial and final SFRs of 80% and 96%, respectively. The mean operative time was 72.15 (95% CI 61.52-82.77) min, and mean hospital stay was 37.31 (95% CI 30.72-43.91) h. The complication rate was 29% (95% CI 18%-44%) with 87% being minor (Clavien-Dindo grades I and II). Comparisons with staged unilateral ureteroscopy showed similar SFRs and cumulative operative time but shorter hospital stays for BSS-URS. Conclusion: BSS-URS is a safe and effective treatment for bilateral urolithiasis, offering advantages in efficiency and patient convenience. However, inconsistencies in outcome definitions and reliance on high-volume centers highlight the need for standardization and further prospective studies to validate its widespread adoption.