28. Ulusal Üroloji Kongresi, Antalya, Türkiye, 10 - 13 Ekim 2019, ss.11-12
BACKGROUND: The incidence of unilateral ureteral stones is approximately 20%, while simultaneous bilateral ureteral stones are rare. These patients represent a potential urological emergency due to possible anuria and / or electrolyte imbalance. While urinary drainage is provided to these patients by emergency intervention in clinical practice, there is not enough data about the frequency of this entity in clinical practice and treatment management. The aim of this study was to define the need for immediate intervention in simultaneous bilateral ureteral stones and to review treatment options.
MATERIAL-METHODS: The records of all patients who underwent ureteroscopy for ureteral stone between April 2017 and June 2019 were reviewed retrospectively. Demographic characteristics, duration of intervention, perioperative data and postoperative results were recorded.
RESULTS: Data of 1846 patients treated for ureteral stones were analyzed. Bilateral ureteral stones were detected simultaneously in 19 patients. Male gender was the majority (15/4). Anuria secondary to bilateral obstruction as well as the most common pain was 31,6%. However, although the serum creatinine values were different before the intervention and at 3 months; the difference was not statistically significant (p = 0,062). At the time of diagnosis, drainage was achieved with DJ ureteral stent in the majority of patients (42,1%). Drainage was achieved in 52,6% of the patients within the first 24 hours after diagnosis (Table 1). The improvement in creatinine values of these patients was also statistically significant (p = 0,023) (Table 2). Bilateral ureteroscopy was the most common choice in early or elective surgical treatment with 84,2%. One patient had antipyretic fever and two patients had early postoperative urinary tract infection. No other complication was observed except for these complications which were grade- 1 according to the modified Clavien classification (Table 1).
CONCLUSION: Unlike the unilateral ureteral stones, early intervention is needed in the treatment of bilateral ureteral stones. In an obstructed urinary system, urgent antegrade percutaneous nephrostomy or retrograde ureteral stent is required to decompress the kidney. These temporary drainage methods are of great importance in patients who cannot have early ureteroscopy. As seen in our study, the earlier the intervention, the greater the improvement in serum creatinine values. Simultaneous bilateral ureteral stones are a rare condition and consecutive operations are performed in the traditional treatment, while bilateral ureteroscopy- guided lithotripsy can be performed in the same session to provide faster and less costly treatment.