Efficacy of Flexible Ureterorenoscopy with Holmium Laser in the Management of Stone-Bearing Caliceal Diverticula

Abstract

F-URS using a holmium laser is a very effective, minimally invasive technique. It could be the best option in managing stone-bearing caliceal diverticula, especially for those patients in whom there was SWL failure. The development of the actively deflectable ureteroscope with miniaturization allowed us to obtain a high success rate, low morbidity, and a brief hospital stay.

Retrograde intrarenal surgery in the management of symptomatic calyceal diverticular stones: a single center experience

“…These figures compare favorably with previously published series of PCNL treatments. Our data showed one-session treatment success rate was 81.4 %, which was similar with those reported by others and was lower than those treated by PCNL [8,21]. But the final treatment success rate after second surgery was 93 %, which was similar with those treated by PCNL.…”

“…As symptomatic calyceal diverticula with stones is a rare disease there is no consensus on treatment. With improving experience and advancements in technology, various available minimally invasive modalities offer the highest symptomatic relief and stone-free rates [6][7][8]. Open surgical treatment has been largely replaced by a number of less invasive surgical and nonsurgical modalities.…”

“…As many other studies had shown, in our study the stone size was an independent variable that affected the stone-free rate, but which could be improved by second procedure. It was documented that the rate of lower pole calyceal diverticula was 10-43 % in different studies [6,8,22]. Some studies described difficulties in accessing the lower pole calyceal diverticula, and retrograde treatment of such diverticula is associated with a significantly lower success rate in some patients [21,23].…”

“…Unlike previous studies, Majed and colleagues described that the success rate in the lower calyx was relatively low compared with the other calices but without significant value. And whatever the location of the calyceal diverticula, they believed RIRS should be proposed as first-line therapy for stone-bearing diverticula with moderate stone burden [8]. Recently, Desai and colleagues described a micro-PCNL technique with reduced bleeding, length of hospital stay and improved analgesia when compared with standard PCNL, in which renal access and stone fragmentation are performed in a single step using a 4.85-F "all-seeing" needle [24].…”

Ureteroscopic Holmium Laser Ablation of a Knotted Ureteral Stent

“…22 It is can also be used for treatment of patients with urethral and ureteral strictures, 23,24 bladder outlet obstruction, 25 and treatment of the caliceal diverticula neck. 26 Notably, holmium laser has been reported as useful in other urologic cases for urinary tract foreign body removal, such as urethral catheters and stone baskets. [27][28][29] In our case, as was reported by Richards and associates, the use of holmium laser delivered via rigid ureteroscopy offers an endoscopic option for the difficult knotted stent removal and that may allow avoidance of percutaneous intervention.…”