Flexible Ureterorenoscopy with Holmium Laser Lithotripsy for Treatment of Calyceal Diverticulum Stone: A Video Article

Introduction: The Calyceal diverticulum represents less than ۰.۵ % of the general population. The incidence of calculi in the calyceal diverticula is between ۱۰ to ۵۰ %. In recent studies, retrograde intrarenal surgeries (RIRS) have been introduced to treat renal stones. We present a case of lower pole stone in a calyceal diverticulum that was refractory to shock wave lithotripsy (SWL) and underwent flexible Ureterorenoscopy (f-URS) with holmium laser lithotripsy. Case presentation: A ۴۸-year-old female with a previous history of renal stones presented to our clinic with a ۱۴mm left lower pole renal stone and calyceal diverticulum. She had a history of SWL failure and a history of right nephrectomy in childhood, so the patient chose to undergo RIRS due to the potential risk of bleeding during the PCNL procedure in a single kidney. An ۱۱/۱۳ Fr ureteral access sheath, an ۸.۷ Fr flexible ureteroscope, and the holmium laser with ۲۰۰ µm fiber laser for incising the diverticular neck and dusting lithotripsy pulverizing the stone fragments less than ۲ mm were applied to the patient. The patient was discharged postoperative day two without any complications. In the follow-up, the patient was asymptomatic, and imaging at three months revealed stone-free status. Conclusion: Flexible ureteroscopy with holmium laser lithotripsy is a viable option for managing stones in calyceal diverticula, especially in single kidney and high-risk patients for bleeding during PCNL.

Keywords:

calyceal diverticulum , Nephrolithiasis , Retrograde Intrarenal Surgery , Holmium laser