Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management

Kymora B. Scotland, Scott G. Hubosky, Ryuta Tanimoto, Robert Cooper, Kelly A. Healy, Demetrius H. Bagley

Research output: Contribution to journalArticle

Abstract

Objective: To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events. Methods: Records of all patients with ureteral stones treated ureteroscopically over an 11-year period were reviewed to identify those with SBUC. Patient presenting characteristics, time from diagnosis to intervention, and postoperative outcomes were noted. To determine the need for emergent intervention, we compared metabolic and infectious parameters between SBUC patients and age- and sex-matched patients with UUC. Results: A total of 3800 patients presented with ureteral calculi including 42 (1.1%) with SBUC. Two-thirds of patients with SBUC had an established diagnosis of nephrolithiasis. Among the 42 patients with SBUC, 11 (26.2%) were considered emergent due to metabolic (5 of 11, 45.5%), infectious (1 of 11, 9.1%), or both metabolic and infectious indications (5 of 11, 45.5%). No patients required acute dialysis before surgical intervention. Compared to patients with UUC, those with SBUC were significantly more likely to require emergent management (P = .03, odds ratio 2.3). Univariate and multivariate analyses showed this to be due to anuria (P = .001) and acidosis (P = .003). Conclusion: SBUC is an uncommon condition and, in this series, only the minority of patients presented emergently. Therefore, patients with SBUC can often be managed electively if counseled on clinical signs warranting emergent medical attention. Appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy.

Original languageEnglish
JournalUrology
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Ureteral Calculi
Anuria
Ureteroscopy
Nephrolithiasis

ASJC Scopus subject areas

  • Urology

Cite this

Scotland, K. B., Hubosky, S. G., Tanimoto, R., Cooper, R., Healy, K. A., & Bagley, D. H. (Accepted/In press). Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management. Urology. https://doi.org/10.1016/j.urology.2018.03.052

Simultaneous Bilateral Ureteral Calculi : A New Paradigm for Management. / Scotland, Kymora B.; Hubosky, Scott G.; Tanimoto, Ryuta; Cooper, Robert; Healy, Kelly A.; Bagley, Demetrius H.

In: Urology, 01.01.2018.

Research output: Contribution to journalArticle

Scotland, KB, Hubosky, SG, Tanimoto, R, Cooper, R, Healy, KA & Bagley, DH 2018, 'Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management', Urology. https://doi.org/10.1016/j.urology.2018.03.052
Scotland KB, Hubosky SG, Tanimoto R, Cooper R, Healy KA, Bagley DH. Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management. Urology. 2018 Jan 1. https://doi.org/10.1016/j.urology.2018.03.052
Scotland, Kymora B. ; Hubosky, Scott G. ; Tanimoto, Ryuta ; Cooper, Robert ; Healy, Kelly A. ; Bagley, Demetrius H. / Simultaneous Bilateral Ureteral Calculi : A New Paradigm for Management. In: Urology. 2018.
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abstract = "Objective: To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events. Methods: Records of all patients with ureteral stones treated ureteroscopically over an 11-year period were reviewed to identify those with SBUC. Patient presenting characteristics, time from diagnosis to intervention, and postoperative outcomes were noted. To determine the need for emergent intervention, we compared metabolic and infectious parameters between SBUC patients and age- and sex-matched patients with UUC. Results: A total of 3800 patients presented with ureteral calculi including 42 (1.1{\%}) with SBUC. Two-thirds of patients with SBUC had an established diagnosis of nephrolithiasis. Among the 42 patients with SBUC, 11 (26.2{\%}) were considered emergent due to metabolic (5 of 11, 45.5{\%}), infectious (1 of 11, 9.1{\%}), or both metabolic and infectious indications (5 of 11, 45.5{\%}). No patients required acute dialysis before surgical intervention. Compared to patients with UUC, those with SBUC were significantly more likely to require emergent management (P = .03, odds ratio 2.3). Univariate and multivariate analyses showed this to be due to anuria (P = .001) and acidosis (P = .003). Conclusion: SBUC is an uncommon condition and, in this series, only the minority of patients presented emergently. Therefore, patients with SBUC can often be managed electively if counseled on clinical signs warranting emergent medical attention. Appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy.",
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AB - Objective: To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events. Methods: Records of all patients with ureteral stones treated ureteroscopically over an 11-year period were reviewed to identify those with SBUC. Patient presenting characteristics, time from diagnosis to intervention, and postoperative outcomes were noted. To determine the need for emergent intervention, we compared metabolic and infectious parameters between SBUC patients and age- and sex-matched patients with UUC. Results: A total of 3800 patients presented with ureteral calculi including 42 (1.1%) with SBUC. Two-thirds of patients with SBUC had an established diagnosis of nephrolithiasis. Among the 42 patients with SBUC, 11 (26.2%) were considered emergent due to metabolic (5 of 11, 45.5%), infectious (1 of 11, 9.1%), or both metabolic and infectious indications (5 of 11, 45.5%). No patients required acute dialysis before surgical intervention. Compared to patients with UUC, those with SBUC were significantly more likely to require emergent management (P = .03, odds ratio 2.3). Univariate and multivariate analyses showed this to be due to anuria (P = .001) and acidosis (P = .003). Conclusion: SBUC is an uncommon condition and, in this series, only the minority of patients presented emergently. Therefore, patients with SBUC can often be managed electively if counseled on clinical signs warranting emergent medical attention. Appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy.

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