Feasibility of Simultaneous Bilateral Endoscopic Surgery in Prone Split-Leg Position for Bilateral Upper Urinary Tract Calculi: A Pilot Study.

Introduction We explored the viability of simultaneous bilateral endoscopic surgery (SBES) in the prone split-leg position for managing bilateral calculi. Methods We retrospectively reviewed 72 patients who underwent SBES, with procedures involving ureteroscopy (URS) and contralateral percutaneous nephrolithotomy (PNL) simultaneously, in prone split-leg position. Results Operative times averaged 109.38±30.76 minutes, with an average hospital stay of 7.79±3.78 days. Bilateral stone-free rate (SFR) was 70.83%, while URS and PNL demonstrated comparable unilateral SFR (83.33% and 79.17%, respectively). Receiver operating characteristics (ROC) curves for predicting unilateral residual fragments yielded an area under the curve (AUC) of 0.84 (URS) and 0.81 (PNL) with respective cut-off values of stone diameter of 11.55 mm and 23.52 mm. 57 (79.17%) and 15 (20.83%) patients encountered grade 0-1/2 complications, with no severe complications (grade 3-5) recorded. No significant changes in blood count or renal function were observed post-SBES. Conclusions SBES in the prone split-leg position is a viable option for managing bilateral upper-tract urolithiasis. Larger-scale studies are needed to further assess safety and efficacy in various positions.