To demonstrate the safety and efficacy of flexible ureteroscopy (FURS) and holmium laser lithotripsy as a valuable treatment of bilateral multiple intrarenal stones and stratify the efficacy by stone burdens s20 and >20 mm. Twenty-five patients with bilateral multiple intrarenal stones were treated with FURS and holmium. lithotripsy at a single clinic. The operative time, stone-free rates (SFRs) per renal unit, stone compositions, number of procedures, serum creatinine, and complications were evaluated. The SFRs were evaluated with computed tomography and plain X-rays of the kidneys, ureters, and bladder. Renal ultrasound was performed 30 days after double-J stent removal to identify hydronephrosis and absence of stones. We defined a stone-free status as the absence of fragments in the kidney or fragments of <1 mm.The total stone number was 128 with a mean stone burden per patient of 24 +- 5 (range 17-37 mm). The overall SFRs per renal unit after 1, 2, and 3 procedures were 70.0%, 92.0%, and 92.0%, respectively. The overall SFRs per renal unit for patients with a preoperative stone burden <20 and >20 mm were 100% and 85.7%, respectively. No major intraoperative or postoperative complications occurred. There were only 4 minor postoperative complications (16%). Our study results firmly suggest that FURS with holmium laser lithotripsy represents a favorable alternative to external shock wave lithotripsy or percutaneous nephrolithotomy for select patients with bilateral multiple intrarenal stones, which have a satisfactory efficacy and low morbidity.
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