Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy E. HOLMAN, A. MUNIM KHAN*, I. PA Â SZTOR² and C. TO Â TH³ Department of Urology, Semmelweis Hospital, Kiskunhalas, Hungary, *Department of Urology & Minimal Invasive Surgery, Millat Hospital, Sadikabad, Pakistan, ²Department of Urology, County Teaching Hospital, Kecskemet, and ³Department of Urology, Debrecen Medical University, Debrecen, Hungary Objective To compare simultaneous bilateral percuta- neous nephrolithotomy SBPCNL) and unilateral PCNL in separate sessions in patients with bilateral renal stones for several variables before and after surgery. Patients and methods The results from SBPCNL carried out at two centres in different countries on 198 patients aged 1.25±70 years) were compared with those from 300 patients undergoing unilateral PCNL in separate sessions. At one centre where extracorporeal shock- wave lithotripsy ESWL) was available SBPCNL was used for stones where at least two sessions of ESWL would have been required on each side. Other asso- ciated procedures were also used wherever required. Results The stones were cleared bilaterally in one session of SBPCNL in 190 patients; in eight, fragments of <3 mm remained but were not clinically signi®cant. A second session was required in six patients on one side only. Variables assessed before and after treatment e.g. hospital stay, analge- sia requirements and complications) were not sig- ni®cantly different between SBPCNL and PCNL. The mean range) total operative duration for SBPCNL was 46 20±100) min and the hospital stay 4.3 3±8) days. Conclusion From this experience, SBPCNL is a cost- effective and bene®cial solution for selected patients, with clear advantages over separate unilateral PCNL in patients with bilateral stones. Keywords percutaneous nephrolithotomy, bilateral, simultaneous Introduction Percutaneous nephrolithotomy PCNL) began to be a routine procedure in developed countries in the early 1980s [1,2] and was considered the procedure of choice for the endoscopic treatment of stones. Even after the introduction of ESWL it is still the method of choice in patients with large, dense or staghorn stones, frequently as monotherapy [3]. The use of simultaneous bilateral PCNL SBPCNL) has been reported [4±6] and herein we report our experience of SBPCNL, comparing it with unilateral PCNL, in patients with bilateral stones. Patients and methods To September 2000, SBPCNL was carried out in two centres by two surgeons in 198 patients 163 male and 35 female, mean age 39 years, range 1.25±70; stones of 1±5 cm in both kidneys); 43 patients 42 unilateral and one bilateral) had recurrent stones after a previous pyelolithotomy Table 1). Five male and one female patient had a haemoglobin level below normal but >100 g/L before surgery. Renal function was assessed before surgery and showed normal values of serum creatinine in 155 patients 78%); the remaining 43 patients 22%) had a mean range) creatinine level of 30 15±55) mg/L. Six patients had staghorn stones on both sides while 14 had unilateral staghorn stones. Four patients underwent endopyelotomy, two laparoscopic uretero- lithotomy and four ureterolithotripsy at the same time as SBPCNL. One patient had a left kidney in the minor pelvis with a stone in it, and underwent laparoscopically assisted PCNL while supine, as described previously [7] and then standard PCNL on the right side after changing the patient's position to prone. Ureteric catheters 6±7 F) were inserted into both kidneys retrogradely in most patients and the patient then positioned prone. In Yemen, the surgery was carried out with the patients under general anaesthesia, while in Pakistan sedation and local anaesthesia was used in all patients except children. The renal area was elevated, and both ¯anks were disinfected and draped separately. As PCNL is a standard procedure only the major points are noted. A telescopic metal dilator set, Accepted for publication 4 December 2001 BJU International 2002), 89, 334±338 # 2002 BJU International 334