TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: Calyceal diverticulum is rare (incidence rate 0.2%-0.6%) and usually related with stone formation, gross hematuria, and infection. Calyceal diverticulum is usually treated by laparoscopic or percutaneous renal access approach. Percutaneous renal access approach is traditionally applied for small calyceal diverticulum (< 2 cm). Laparoscopic approach is usually introduced for larger or anterior calyceal diverticulum, but its postoperative morbidity is not as good as percutaneous method.

wceMethods: A 60 years old female presented with intermittent gross hematuria, right flank pain and image revealed a large 7.3 x 5.3 cm sized calyceal diverticulum in lower anterior portion of right kidney. Under general anesthesia, the patient was placed in prone position for percutaneous renal access surgery. First, whole surface of calyceal diverticulum was fulgurated with bipolar resectoscope and the narrow infundibulum was incised by Holmium-YAG Laser. After entering the collecting system, double J stent was placed antegrade. Finally, 24 Fr nephrostomy tube was inserted into collecting system for decompression.

Results: The operative time took for 185min and estimated blood loss was less than 50ml. Nephrostomy tube was placed for one month and double J stent was placed for 2 months. This help to remain low intrapelvic pressure and provide sufficient time to let the huge calyceal diverticulum sealed. MRI on postoperative three months showed huge calyceal diverticulumhad complete resolution.

Conclusions: Percutaneous renal access for huge anterior calyceal diverticulum is also possible to achieve complete resolution like laparoscopic approach but without the related morbidity from laparoscopic method.

Source of Funding: None

 
Listen to an interview with Meng-Lin Chang, one of the authors of this study.

 

Presented by Meng-Lin Chang, Shih-Chang Fuh, Ting-Jui Change, and Chih-Kai Hsu at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

Taipei Medical University Hospital, Taiwan

 

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