Orhun Sinanoglu et al., 2024: Bilateral ureteral stones; factors affecting treatment decision

Orhun Sinanoglu 1 , Salih Yildirim 2 , Ferhat Yakup Suceken 3 , Fatih Bicaklioglu 4 , Mehmet Erhan Aydin 5 , Mehmet Uslu 6 , Ozgur Arikan 7 , Kemal Sarica 2 8
1Department of Urology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
2.Department of Urology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
3Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey.
4Department of Urology, Kartal Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
5Department of Urology, Eskisehir City Hospital, Eskisehir, Turkey.
6Department of Urology, Kafkas University Medical School, Kars, Turkey.
7Department of Urology, Istanbul Medeniyet University Goztepe Suleyman Yalcin City Hospital, Istanbul, Turkey.
8Biruni University, Faculty of Medicine, Istanbul, Turkey.

Abstract

Aim: To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones.

Methods: A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups.

Results: While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option.

Conclusions: Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.

Urolithiasis. 2024 May 23;52(1):76. doi: 10.1007/s00240-024-01573-4 PMID: 38780633