V1721: Retrograde Intrarenal Surgery for Treatment of Calyceal Diverticulum with Concomitant Renal Calculi

Video

Introduction and Objectives
The presence of symptomatic renal calculi within a calyceal diverticulum, especially a small one, can pose a treatment challenge to a practicing urologist. We present our technique of retrograde intrarenal surgery as a viable option for optimal therapy.

Methods
CT scan and retrograde pyelogram was diagnostic for a calyceal diverticulum containing numerous calculi. Options were discussed including a percutaneous renal surgery, laparoscopy, and retrograde intrarenal surgery. Based on the distance from the renal capsule, body habitus, and small size of the diverticulum, the decision was made to perform a retrograde approach.

Results
Retrograde intrarenal surgery was performed with the aid of the flexible ureteroscope, holmium laser, and fluoroscopic guidance. Once the wall of the diverticulum was localized within the renal pelvis, the holmium laser was used to enter the diverticulum. Upon entry, multiple renal calculi were identified. Basket extraction was performed along with holmium laser lithotripsy. A double-j ureteral stent was placed once the larger stones had been extracted and a large enough channel had been created for easy passage of the residual fragments.

Conclusions
Retrograde intrarenal surgery for the treatment of calyceal diverticulum with concomitant renal calculi is a viable option. Patient selection is crucial when choosing the best approach for treatment.

Funding: none