V9-07: Infundibuloplasty of Calyceal Diverticula Using Modified Percutaneous Technique

Video

Introductions and Objectives
A calyceal diverticulum is an entity that requires a high index of suspicion on the part of the treating urologist. It may predispose patients to stone formation, chronic pain, or recurrent bacteriuria and infections. Failure to identify this condition may result in inappropriate treatment selection with a high risk of persistence of the cavity, calculi, and their associated signs and symptoms. Multiple approaches have been described in the treatment of calyceal diverticula, including ureteroscopic, percutaneous, and laparoscopic. The following case describes a modified percutaneous nephrolithotomy technique with infundibuloplasty for the treatment of calyceal diverticula with nephrolithiasis.

Methods
A 50 year old man presented with acute left renal colic, and computed tomography (CT) scan revealed a 1.5cm conglomeration of renal calculi that was characteristic of a calyceal diverticulum, as well as two small ureteral calculi. The patient failed medical expulsive therapy and was referred for endourologic consultation. Due to the relative size of the patient’s total stone burden, the decision was made to undergo percutaneous approach for definitive treatment and to render the patient completely stone-free.

Results
Fluoroscopically guided renal access was obtained directly into the diverticular cavity using standard triangulation method and Seldinger technique. The tract was dilated to 24Fr access and a nephroscope without outer sheath was used for the principal portion of the procedure. All calculi were removed and balloon dilation infundibuloplasty of the diverticular neck was performed. The epithelial lining of the cavity was ablated using electrocautery. Operative time was 126 minutes and the procedure was well-tolerated without intraoperative or post-surgical complication.

Conclusions
This video demonstrates that a percutaneous approach with 24Fr access can safely and efficiently be used for nephrolithotomy with infundibuloplasty in patients with calyceal diverticula with large stone burden. This procedure is a feasible comprehensive approach for endourologists well versed in percutaneous renal surgery.

Funding: none