Renal calculi represent a significant and rising global health burden. Bilateral renal stones, treated traditionally via staged interventions, contribute substantially to patient morbidity and healthcare expenditure. Simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL) presents a promising alternative, potentially reducing cumulative hospitalization and anesthesia exposure while maintaining efficacy. This study evaluates the safety, efficiency, and clinical outcomes of SB- PCNL in a Sri Lankan cohort.

A prospective descriptive study was conducted among 63 patients with bilateral renal stones who underwent SB-PCNL from January 2016 to August 2024 across five geographically diverse Sri Lankan hospitals. A novel operative technique was utilized: both sides were cleaned and draped simultaneously, and bilateral punctures were made at the outset. The less complex side was dealt with first, and neither the operating table nor the image intensifier was altered from the original position. The higher Guy’s Stone Score (GSS) between the two kidneys was used for assessment. Data on stone characteristics, operative parameters, stone-free rates (SFRs), and postoperative outcomes were analyzed.

The mean age was 47.4 ± 12.3 years, with a male predominance (74.6%). The mean stone size was 1.38 ± 0.84 cm, with the largest measuring 5.3 cm. Mean operative time was 57.3 ± 12.6 minutes, showing a decreasing trend over the study period. Mean hospital stay was 2.07 ± 0.46 days, with earlier discharges observed in private sector settings. The overall SFR was 92.1%, with residual fragments in 7.9% of cases—mainly associated with high-density stones (>1200 HU) and lower calyceal locations. A weak positive correlation (r = 0.27) was observed between GSS and operative time. Among the 31 stone analyses performed, 26 (83.9%) were predominantly composed of calcium oxalate monohydrate, while the remaining included calcium oxalate dihydrate (3 cases), carbonate apatite (1 case), and uric acid (1 case).

SB-PCNL is a safe and effective option for bilateral renal stones, achieving high SFRs with reduced hospitalization and morbidity. Variability in discharge timelines highlights the need for standardized postoperative protocols. Future studies should explore flexible nephroscopy and adjunctive techniques for improved stone clearance. A randomized controlled trial comparing SB-PCNL with staged procedures is warranted to establish definitive clinical guidelines.