This systematic review evaluates the efficacy and safety of bilateral single-session ureteroscopy (BSS-URS) in treating bilateral urolithiasis, focusing on primary outcomes such as stone-free rate (SFR), complication rate, operative time, and hospital stay.

A systematic search of MEDLINE, EMBASE, and CENTRAL databases was conducted, identifying 476 papers. 18 studies from 2012 to 2024 comprising of 2,904 patients (1918 male, 986 female) were included in the final review. Data on patient demographics, procedural outcomes, and complications were extracted and analyzed.

2,294 patients underwent BSS-URS, while 610 underwent the traditional staged unilateral ureteroscopy (SU-URS). The mean age of all patients was 43.2 years, average body mass index (BMI) was 27.0 kg/m2 and average stone burden was 18.8 mm. The overall mean SFR for BSS-URS was 85.1% while the overall mean SFR for SU-URS was 85.5%. The mean operative time for BSS-URS was 74.4 minutes for both renal units while the mean operative time for SU-URS was 46.2 minutes per single renal unit. The mean hospital stay duration for BSS-URS was 33.5 hours, while for SU-URS it was 34.6 hours. The overall complication rate for BSS-URS was 28.3% with 87.2% of all complications being minor (Clavien-Dindo I & II). Major complications (Clavien-Dindo ≥IIIa) occurred in 3.6% of all cases with urosepsis requiring ICU admission being the most common (1.2%). No patients had Clavien-Dindo grade IVb and V complications.

BSS-URS is a safe and effective treatment for bilateral urolithiasis, offering advantages in reduced accumulative hospital stay and operative time with comparable SFR. While the overall complication rate for BSS-URS remains slightly elevated, most complications are minor, with serious complications being rare and manageable. However, inconsistencies in SFR outcome definitions and reliance on high-volume centers highlight the need for standardization and further prospective studies to validate its widespread adoption.