Efficacy of flexible ureterorenoscopy with holmium laser in the management of calyceal diverticular calculi

Abstract

The purpose of this study was to evaluate the efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy in the management of calyceal diverticular calculi. In this study, we retrospectively analyzed the clinical data of 27 patients with calyceal diverticular calculi admitted to the Department of Urology of the Zigong First People's Hospital from May 2018 to May 2021. Intraoperatively, the diverticular neck was found in all 27 patients, but flexible ureterorenoscopy lithotripsy was not performed in 2 cases because of the slender diverticular neck, and the success rate of the operation was 92.6%. Of the 25 patients with successful lithotripsy, the mean operative time was 76.9 ± 35.5 (43-200) min. There were no serious intraoperative complications such as ureteral perforation, mucosal avulsion, or hemorrhage. Postoperative minor complications (Clavien classification I-II) occurred in 4 (16%) patients. The mean hospital stay was 4.4 ± 1.7 (3-12) days. The stone-free rate was 80% at the 1-month postoperative follow-up. After the second-stage treatment, the stone-free rate was 88%. In 22 cases with complete stone clearance, no stone recurrence was observed at 5.3 ± 2.6 (3-12) months follow-up. This retrospective study demonstrated that flexible ureterorenoscopy with holmium laser is a safe and effective choice for the treatment of calyceal diverticular calculi, because it utilizes the natural lumen of the human body and has the advantages of less trauma, fewer complications, and a higher stone-free rate.

Keywords: Calyceal diverticula; Calyceal diverticular calculi; Flexible ureterorenoscopy; Holmium laser; Stone.

Fig. 1

The procedure of F-URS with holmium laser treatment for CDC. A The tip of the holmium laser was pointing at the diverticular neck; B insertion of a zebra guidewire into the diverticular neck for exploration; C holmium laser incision of the diverticular neck opening along the mucosal hypovascular areas; D flexible ureteroscope entered the diverticulum for lithotripsy (multiple stones can be seen in the diverticulum)

Fig. 2

Preoperative and intraoperative imaging data of failed F-URS lithotripsy case 1. A CT coronal image shows that the stone was in the diverticulum of the middle calyx of the right kidney. The slender neck of the diverticulum (approximately 6 mm in length) was marked by the yellow arrow; B the diverticular neck opening; C guidewire exploration of the diverticular neck opening; D purulent fluid was seen flowing from the opening after removal of the guidewire