When you treat a symptomatic ureteral stone with URS, do you also treat an asymptomatic contralateral nonobstructing renal stone in the same session?

Great question. Whenever I offer patients surgical stone treatments, I review their imaging with them, including the stone burden in both kidneys. I focus the discussion on the symptomatic side, but also review any contralateral stone burden and the potential for developing subsequent symptoms or concerns. Based on the publication (Sorensen et al., PMID 35947709), I generally offer patients the option of treating any contralateral stone burden to potentially decrease relapse, but I frame the discussion in terms of how complicated I suspect treating the symptomatic side may be, the likelihood of needing a stent or staged surgery on the contralateral side, and the patients' overall willingness to consider bilateral treatment.

In the early days of ureteroscopy, several single-use devices were developed to prevent migration of the ureteral stones or stone fragments back up to the kidney (Stone Cone®, Backstop®, etc.). Currently, with innovations in single-use ureteroscopes and the advent of suction technology, access to stones in the collecting system has become routine. Moreover, previous studies have demonstrated that removing asymptomatic renal stones either ipsilaterally or contralaterally reduces the risk that these asymptomatic calculi may result in future stone episodes.

It is therefore our routine to treat ipsilateral asymptomatic renal calculi when removing a symptomatic ureteral stone with informed consent. Preoperatively, we will also discuss with the p...

Fantastic question. I don't think there is a single right answer. Data would suggest that bilateral treatment is safe and that active treatment may reduce subsequent stone events, but I generally recommend that this be a highly patient-specific decision. A couple of points I would emphasize:

1. Make sure the patient is informed about the contralateral stone. I am shocked at how many patients with a unilateral ureteral stone are not informed of a small or sometimes even substantially sized stone on the other side.
2. Does the stone (or patient) have any red flags that might push you towards recommending treatment? History of recurrent UTI, stone located in renal pelvis, intermittent pain, rapid stone growth. Also consider social factors into cons...