Bilateral single-session ureteroscopy (BSS-URS) is increasingly adopted for bilateral urolithiasis due to potential advantages in surgical efficiency and patient convenience. This systematic review aims to evaluate the efficacy and safety of BSS-URS, focusing on stone-free rate (SFR), complication rate, operative time, and hospital stay.

A comprehensive search of MEDLINE, EMBASE, and CENTRAL databases was conducted in accordance with PRISMA guidelines. Eighteen studies involving 2,904 patients met inclusion criteria. Data were extracted on patient demographics, outcomes, and complications. The Newcastle-Ottawa Scale was used to assess risk of bias.

The mean overall SFR for BSS-URS was 85.1%, with initial and final SFRs of 79.88% and 95.54%, respectively. Average operative time was 74.46 minutes, and mean hospital stay was 33.48 hours. The overall complication rate was 29.2%, of which 86.7% were minor (Clavien-Dindo grades I–II). Major complications (≥Grade IIIa) occurred in only 3.9% of cases. Compared to staged unilateral ureteroscopy (SU-URS), BSS-URS had comparable SFRs but reduced total operative and hospital time.

BSS-URS appears to be a safe and effective treatment for bilateral urolithiasis with comparable stone clearance and a favorable complication profile. While most complications are minor, standardized definitions of outcomes and prospective multicentre trials are needed to validate these findings and support broader implementation.