Review Article Safety, Feasibility, and Efficacy of Bilateral Synchronous Percutaneous Nephrolithotomy for Bilateral Stone Disease: Evidence from a Systematic Review Patrick Jones, MRCS, 1 Blessing Dhliwayo, FRCS, 1 Bhavan Prasad Rai, FRCS, 2 Moeketsi Mokete, FRCS, 1 Ramachandran Amitharaj, 3 Omar M. Aboumarzouk, FRCS, 4 and Bhaskar K. Somani, FRCS 5 Abstract Introduction: With the evolution of endourologic technology, bilateral synchronous percutaneous ne- phrolithotomy (BS-PCNL) has emerged as a potentially practical intervention for patients with bilateral lithi- asis. Although tradition has favored a staged approach, an increasing number of original studies have reported their experiences with the synchronous approach. Materials and Methods: A Cochrane style search was performed after development of a sensitive and predefined search strategy. Primary outcomes measured were initial and final stone-free rate (SFR), drop in hemoglobin, hospital stay, operative time, and complication rates. Additional information was collected on (but not limited to) baseline characteristics, stone complexity, number of tracts made, success rate, and transfusion rate. Results: From a total 187 studies, 11 were identified (published between 1997 and 2015), and they were included in this review. In total, 594 patients with a mean age of 46 years and a male:female ratio of 3:1 underwent BS-PCNL procedures, the majority of which was under the prone position. In 87.1% (range: 71.4%– 100%) of cases, the synchronous approach was performed as planned. Multiple access tracts were established in an average of 16.7% (4.1%–24%) renal units. Mean initial SFR and final SFR were 72.6% (49%–85%) and 92.4% (87%–96.9%), respectively, with a mean operative time of 171.1 minutes (range: 107.4–269 minutes). Mean hospital stay was 3.9 days (range: 1.25–15 days). Mean complication rate per study was 23.4% (range: 12.1%–54% per study). The majority were Clavien Grade 1 (60.9%), of which fever resolving spontaneously was the most common complication. No deaths were reported in any of the papers. Conclusion: BS-PCNL seems to be a good endourologic approach for patients with bilateral stone disease, which can render high SFRs and maintain a noninferior safety profile compared with the staged approach. This technique demands careful patient selection, counseling and should be preferably performed in endourology centers with large case volumes. Keywords: percutaneous nephrolithotomy, urolithiasis, endourology Introduction P ercutaneous nephrolithotomy (PCNL) is the bench- mark intervention for complex urinary stones and has undergone significant advancements since it was first described in 1976. 1 With the evolvement of technique and technology, in cases of bilateral stone disease, bilateral synchronous percuta- neous nephrolithotomy (BS-PCNL) has emerged in recent years as a potential treatment solution in the endourologist’s armamentarium. 2 Given its potential for reducing total anes- thetic time and hospital stay and the need to re-operate, it may represent an expeditious choice for stone clearance in both kidneys. However, concerns persist regarding its safety and, as such, standard tradition has favored a staged (also termed asynchronous) approach. The question remains, therefore, as to whether the asyn- chronous staged approach is driven by conventional habit, custom, or clinical necessity. However, although there have 1 Department of Urology, Royal Preston Hospital, Preston, United Kingdom. 2 Department of Urology, The James Cook University Hospital, Middlesbrough, United Kingdom. 3 Department of Urology, County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom. 4 Department of Urology, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, United Kingdom. 5 Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom. JOURNAL OF ENDOUROLOGY Volume 31, Number 4, April 2017 ª Mary Ann Liebert, Inc. Pp. ---–--- DOI: 10.1089/end.2016.0851 1