In their meta-analysis, Jones and colleagues found that bilateral synchronous percutaneous nephrolithotomy (BS-PCNL) was associated with similar stone-free outcomes and complication rates as those reported for unilateral PCNL. The authors have done an excellent job in emphasizing that BS-PCNL has primarily been reported by high-volume centers. Previous investigations have demonstrated that PCNL outcomes are better and complication rates are lower at high-volume centers.
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Institutions that perform few PCNLs should be cautious about performing simultaneous bilateral procedures as their complication rate may be higher and exposing the patient to acute kidney injury could prove devastating. Even in centers with extensive experience, it is important for the surgical and anesthesia teams to be constantly assessing the progression of the case. Should intraoperative findings or duration of the first side procedure be unfavorable, the surgeon should not hesitate to change his or her mind and leave the second side for another day.
In summary, for patients with bilateral stones that merit PCNL, a bilateral synchronous procedure may be a good cost-effective option at experienced centers.
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This approach diminishes the burden of care for patients in centers where long distance and economic livelihoods promote this approach. As in any procedure, the complication rates and outcomes achieved at high-volume centers may not be reproducible for every urologist and these differences should be kept in mind during surgical planning and patient counseling.
