V05-10 PARTIAL NEPHRECTOMY IN THE TREATMENT OF A POSTERIOR EXCLUDED CALYCEAL DIVERTICULUM WITH A RENAL CALCULUS

Abstract

You have accessJournal of UrologyUrolithiasis & Endourology (V05)1 Sep 2021V05-10 PARTIAL NEPHRECTOMY IN THE TREATMENT OF A POSTERIOR EXCLUDED CALYCEAL DIVERTICULUM WITH A RENAL CALCULUS Sho Yoshitake, Joshua Sterling, and Sammy Elsamra Sho YoshitakeSho Yoshitake More articles by this author , Joshua SterlingJoshua Sterling More articles by this author , and Sammy ElsamraSammy Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002012.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Calyceal diverticula (CD) are protrusions of renal calyces surrounded by renal parenchyma. They are rare and usually asymptomatic. However, they can cause recurrent flank pain, hematuria, and urinary tract infections. Treatment has classically included shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL). SWL can improve symptoms but does not treat the underlying CD. URS is limited to CD with favorable anatomy. PCNL is considered first-line. However, it is not recommended for supracostal or anterior CD and is avoided in patients averse to a nephrostomy tube or ureteral stent. There are limited reports of robotic partial nephrectomy in the treatment of CD and no reports of retroperitoneal robotic approaches, to our knowledge. Yet, robotic partial nephrectomy is a promising option. It treats both the CD and the stones within; ureteral stents or nephrostomy tubes are not needed; and supracostal CD are not contraindicated. In this video, we present a case of a posterior excluded CD with a renal calculus refractory to SWL treated with robotic partial nephrectomy. METHODS: The procedure was performed with the da Vinci Xi system. Patient was placed in the right lateral decubitus position. Following a 12-mm mid-axillary incision, access to the retroperitoneum was gained. A Spacemaker Hasson trocar with the balloon dilator was placed into the retroperitoneum and the balloon was dilated. Ports were placed in standard position for a robotic retroperitoneoscopic renal surgery. The kidney was then elevated and the renal hilum was dissected out. Intraoperative ultrasound was performed to identify the location of the CD with the stone. Following placement of two bulldog clamps on the renal artery, the CD was excised. Deep and capsular renorrhaphy were conducted to close the defect in the collecting system. The bulldogs were then removed, and hemostasis was gained. By the end of the case, there was excellent hemostasis, and a 15-French Blake drain was placed into the retroperitoneal space posterior to the kidney. RESULTS: There were no intra-operative complications. Pathology was consistent with a CD with renal calculi. After an uncomplicated post-operative stay, she was discharged to her home after 1 day. 3 weeks later, she was seen in the office and was symptom free. CONCLUSIONS: Excluded CD with renal calculi have classically been treated with SWL, URS, and PCNL. Robotic partial nephrectomy is a safe, efficient, and often overlooked treatment for stones in an excluded CD. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e389-e389 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sho Yoshitake More articles by this author Joshua Sterling More articles by this author Sammy Elsamra More articles by this author Expand All Advertisement Loading ...