Calyceal Diverticulum Research Articles

Radiological evaluation of a calyceal diverticulum presenting with hematuria

Calyceal diverticulum, also known as pyelogenic cysts, is a relatively uncommon condition, usually asymptomatic and incidentally diagnosed during routine imaging. Sometimes it may lead to concerning symptoms such as hematuria and flank pain, mimicking the presence of a renal tumor. In this case report, the patient suffered from hematuria which was initially suspected to be indicative of a renal malignancy but that was ultimately attributed to a calyceal diverticulum. The reported case gives the opportunity to evaluate one of the rarest and underestimated causes of hematuria and to describe the main imaging features of the calyceal diverticulum. In particular, the following diagnostic imaging methods have been performed: Ultrasound, Computed Tomography Urography, Dual Energy Computed Tomography, and Magnetic Resonance Urography. Subsequently, this case report has also an educative purpose.

Daily habits and kidney stones development rate. Literature review

Introduction: Kidney stones disease is a medical condition when hard deposites made of various minerals and substances form inside kidneys. It may lead to clinical symptoms as severe pain felt in the belly area or side of the back. Also it can radiate and reach testicles, groin area, labia. Other symptoms may include blood in the urine, abnormal color of urine, fever, nausea, vomiting. Because of growing incidence rate- adequate question is how can we protect ourselves from kidney stones development by changing habits.
 
 Aim of study: Fundamental aim of study is to demonstrate how daily, routine habits changes may have a huge impact on kidney stones development risk.
 
 State of knowledge: There are a lot of confirmed parameters and factors which can lead to kidney stones devolopment. Factors that increase risk of developing kidney stones include: dehydration, diet (meat intake, fruit/vegetables intake, sodium intake), family or personal history, obesity, digestive diseases and surgery, metabolic disorders, urinary track infections, anatomical abnormalities- obstruction of the kidney, calyceal diverticulum, horseshoe kidney, ureterocele. This group includes many modified factors, so lifetime risk of kidney stones depends also on our habits and way of life.
 
 Conclusion: There are many modified factors which may lead to this disease and because of that it is crucial to improve patients and whole society awareness about them. By appropriate daily habits changes we can significantly reduce risk of lifetime kidney stone disease development. It is important to know that concrete reports and analyses were made and they demonstrated scientifically proven correlations.

Calyceal Diverticulum Found Incidentally on 18 F-FDG PET/CT Imaging.

A 69-year-old man with pancreatic cancer underwent 18 F-FDG PET/CT examination for tumor staging. The PET images showed a focal mass-like FDG accumulation in the left kidney mimicking malignancy, whereas simultaneous CT and fused PET/CT images suggested a cystic lesion. On subsequent MR examination, the lesion appeared cystic on T2-weighted, contrast-enhanced arterial phase, and contrast-enhanced venous phase images. In addition, excretory phase images showed filling contrast medium to the cystic cavity, leading to a diagnosis of calyceal diverticulum. This report suggests that the possibility of a calyceal diverticulum should be considered in cases with focal FDG accumulation in renal cystic lesions.

The Pathophysiology of Inherited Renal Cystic Diseases.

Renal cystic diseases (RCDs) can arise from utero to early adulthood and present with a variety of symptoms including renal, hepatic, and cardiovascular manifestations. It is well known that common RCDs such as autosomal polycystic kidney disease and autosomal recessive kidney disease are linked to genes such as PKD1 and PKHD1, respectively. However, it is important to investigate the genetic pathophysiology of how these gene mutations lead to clinical symptoms and include some of the less-studied RCDs, such as autosomal dominant tubulointerstitial kidney disease, multicystic dysplastic kidney, Zellweger syndrome, calyceal diverticula, and more. We plan to take a thorough look into the genetic involvement and clinical sequalae of a number of RCDs with the goal of helping to guide diagnosis, counseling, and treatment.

Is the presence of upper tract transitional cell carcinoma in a calyceal diverticulum a risk factor for early metastasis? A case report and review of the literature

Upper tract transitional cell carcinoma poses diagnostic challenges due to its prevalence and diverse clinical presentations. This case report describes the incidental discovery of high-grade transitional cell carcinoma during the management of a 48-year-old male with ischemic heart disease and an asymptomatic right renal stone. During flexible ureteroscopy for stone removal, papillary lesions were identified within a calyceal diverticulum and confirmed as high-grade transitional cell carcinoma. The unique anatomy of the calyceal diverticulum, characterized by its restricted wall thickness, may predispose the tumor to early metastasis. Additionally, there is a concern about potential iatrogenic dissemination of tumor cells to the bladder during the ureteroscopic procedure. This case highlights the diagnostic complexities associated with upper tract transitional cell carcinoma in rare anatomical locations and emphasizes the need for careful consideration of both procedural factors and anatomical features to manage the risk of metastasis and tumor dissemination effectively.

Percutaneous treatment of stone containing calyceal diverticula: Strategies and outcomes from a University teaching hospital in a developing country.

There is a dearth of research available on the outcomes, complications, and recurrence rates of the modalities employed in treatment of diverticula after stone clearance by PCNL. We present our experience of various approaches employed in our institute for treatment of caliceal diverticulum after stone clearance by PCNL. We aimed to review the outcomes, complications, and recurrence rates of these procedures which can provide valuable insights into the effectiveness of these techniques in the treatment of stone containing caliceal diverticulum. A retrospective analysis of a prospectively maintained database of patients diagnosed with caliceal diverticular stone was conducted. The primary outcome was the stone-free rate (SFR) at the time of hospital discharge, determined by a combined nephroscopic/fluoroscopic assessment, and the obliteration of the diverticular sac. Secondary outcomes included the evaluation of operative time, duration of hospital stay and postoperative complications. A total of 53 patients were evaluated. The mean diverticulum size was 23.2 mm, most common location was the superior calyx (30 (56.7%)). Group 1 (diverticular neck treatment + DJ stent) included 27 patients, group 2 (diverticular wall fulguration + PCN) included 18 patients and group 3 (PCN alone) included 8 patients. Mean operating time was highest in group 1 (80 min). Stone clearance was 100% in group 1, 91% in group 2 and 88% in group 3. Obliteration of caliceal diverticulum was highest in group 1 (90%). Mean duration of hospital stay was lowest in group 1 (3.2 days). Overall complications were lowest in group 2 (3/18). PCNL followed by combination of diverticular wall fulguration and PCN or treatment of diverticular neck and DJ stenting is safe and effective in causing diverticular obliteration. Placement of nephrostomy tube alone was not found to be effective in causing diverticular obliteration in our study.

A multicenter propensity score matched pair study in 313 patients comparing percutaneous nephrolithotomy versus retrograde intra renal surgery for management of urolithiasis in calyceal diverticulum

A multicenter propensity score matched pair study in 313 patients comparing percutaneous nephrolithotomy versus retrograde intra renal surgery for management of urolithiasis in calyceal diverticulum

Ретророградная интраренальная хирургия заболеваний почек

Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures.To study the results of RIRS in patients with nephrolithiasis and various renal disorders.A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+/-15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done.RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+/-10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (n=7) and repeated RIRS (n=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+/-16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+/-8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 +/- 20.5 minutes) and there were no complications.RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.

Percutaneous endoscopic creation of a neoinfundibulum for a calyceal diverticulum: A case report and review of the literature

IntroductionCalyceal diverticula (CD) are cystic structures within the renal parenchyma that likely result from inappropriate interaction between the ureteric bud and metanephric blastema during development and, if obstructed, may cause problems that include flank pain, urinary tract infections, gross hematuria, or nephrolithiasis. Herein, we present the results of percutaneous management of an obstructed calyceal diverticulum causing recurrent flank pain and infections in a 17-year-old girl.Case summaryThe patient initially presented with febrile pyelonephritis, at which time an ultrasound was concerned about an abscess versus an infected cyst. She underwent percutaneous drain placement with IV antibiotics and improved. Three years later, she re-presented with similar symptoms. After a similar treatment course, a sinogram revealed communication of the cystic-appearing lesion with the proximal ureter, confirming a diagnosis of a calyceal diverticulum. The patient opted for endoscopic management. An initial attempt at ureteroscopy was unsuccessful due to both the small ureteral caliber as well as the stenotic infundibular os. A repeat attempt at percutaneous management revealed a stenotic infundibulum that could not accommodate a wire. A holmium laser fiber was used to create a neoinfundibulum from the diverticulum to the renal pelvis adjacent to the stenotic infundibular os. Follow-up retrograde pyelography and ultrasonography confirmed an interval decrease in size of the infundibulum, and the patient’s infectious symptoms and pain resolved.DiscussionCD is a rare anomaly and is infrequently reported in the pediatric population. Percutaneous management of CD in adults has been well described in the literature. Direct percutaneous management of CD involves access to the CD and ablation of the CD cavity to prevent re-accumulation of urine. Previous studies done in adults have suggested that stone-free rates from this management range from about 80% to 100%. Diverticular obliteration, as measured by postoperative CT scans, also appears to be feasible in a percutaneous, antegrade approach, with complete diverticular obliteration rates ranging from 60% to 100%. Our case demonstrated a successful decrease in size from the original diverticulum (9 cm) to a smaller size (2 cm). Future studies with longer follow-ups will need to ascertain if percutaneous management of symptomatic CD is effective in the pediatric population.

Prolonged postoperative urine leakage due to a calyceal diverticulum mimicking a renal cyst: A case report and literature review

BackgroundThe calyceal diverticulum is a rare cystic cavity that communicates with the collecting system via a narrow neck or infundibulum. In clinical practice, part of the calyceal diverticula is difficult to differentiate from simple renal cysts even after contrast-enhanced CT. To date, there have been few kinds of literature works on the diagnosis and treatment of calyceal diverticulum combined with renal pelvis dilatation, especially concerning the treatment of prolonged postoperative urine leakage.Case descriptionA 53-year-old woman with calyceal diverticulum and renal pelvis dilatation mimicking a simple renal cyst suffered urine leakage after receiving laparoscopic unroofing of the renal cyst. A persistent urine leakage was observed immediately after surgery, with about 200 ml of drainage fluid per day. We first attempted to place a double-J ureteral stent and indwell a catheter. After failing that, conservative treatment was performed. The core idea of the conservative treatment is retaining the drainage tube for more than 1 month, then clamping the drainage tube for 1 week, and finally removing the drainage tube. By 3 weeks of follow-up, the urine leakage disappeared, and the CT scan showed hydronephrosis of the right kidney without perirenal exudation and the lower pole cyst of the right kidney shrank significantly.ConclusionThis case, we reported here, is to attract the attention of clinicians. Renal cysts should exclude the possibility of the calyceal diverticulum. If urine leakage is inevitable after surgical treatment, our conservative treatment strategy is also an alternative method.

The treatment option for calyceal diverticulum stones: flexible ureteroscopy lithotripsy (FURL) or all-seeing needle-assisted percutaneous nephrolithotomy (PCNL)?

The purpose of this study was to investigate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) and all-seeing needle-assisted percutaneous nephrolithotomy (PCNL) for the treatment of calyceal diverticula (CD) stones. From June 2012 to November 2020, 24 patients, including 14 females and 10 males, with an average age of 45.6 ± 17.4years were retrospectively reviewed in this study. Among these patients, 14 were treated with FURL, and 10 underwent all-seeing needle-assisted PCNL. The demographic data, perioperative parameters and complications, as well as follow-up data, were recorded. In the FURL group, the ostium of CD was not identified in two patients, and these patients were finally treated with all-seeing needle-assisted PCNL. The stone clearance rate (SCR) was 64.3%, and the mean blood loss was 0.9 ± 0.8g/dL. The average operation time was 57.5 ± 17.4min, and the mean hospital stay was 3.5 ± 1.4days. A complete resolution of CD was observed in five (41.7%) patients over the average follow-up of 10.8months. In terms of the all-seeing needle-assisted PCNL, the average operation time was 83.5 ± 32.4min, and the mean hospital stay was 4.38 ± 2.25days. The SCR reached 91.7%, and the blood loss was 1.7 ± 1.1g/dL. Nine patients (75%) were observed to have complete CD resolution over an average of 12.2months of follow-up. All complications were grade I and II in both the groups. CD stones can be treated minimally invasive and effectively by FURL and PCNL. The effect of FURL greatly depends on the location and anatomy of the diverticula. PCNL is more efficient, and its safety was improved with the help of the all-seeing needle assistance.

Type 2 calyceal diverticulum with an unusual appearance in the lower pole of the kidney

A 45-year-old woman presented to our clinic with intermittent left flank pain. The family physician referred her for renal cystic mass with a calcified appearance. The non-contrast spiral abdominal computed tomographic (CT) scan demonstrated the mass-like cystic lesion with a densely calcified lesion in the lower pole of the kidney. A detailed history revealed that she underwent shock wave lithotripsy (SWL) for the lower pole renal stone one year ago. After SWL, the stone fragments migrated to the dependent diverticulum region and produced the misleading appearance of a Bosniak type III lesion. Contrast-enhanced computed tomography (CT) scan was done for further evaluation, and finally, the diagnosis of the calyceal diverticulum was confirmed in the lower pole of the kidney. Calyceal diverticula are the outpouching of the pyelocalyceal system lined by non-secretory transitional epithelium. It is a rare condition that occurs in less than 0.5% of the population. Most patients are asymptomatic and have been discovered incidentally in routine imaging modalities. As most of the patients are asymptomatic, many do not need intervention. However, in some instances, patients present with flank pain, hematuria, urinary tract infection, and stone formation in the diverticulum. They are in the differential diagnosis of renal cystic lesions such as simple renal cyst, renal cortical abscess, and parapelvic cyst. In renal cystic lesion besides of simple renal cyst or renal cystic mass, we should keep the differential diagnosis of the calyceal diverticulum type 2, especially in patients that underwent SWL for renal stones; the fragmented residual stone may have migrated to this dilated region and produce the deceptive appearance of a Bosniak type III lesion.

Could "Retrograde Intrarenal Surgery" be Used as an Efficient Technique in the Treatment of Calyceal Diverticula Stones.

To evaluate the efficacy of retrograde intrarenal surgery (RIRS) and holmium laser lithotripsy in the treatment of symptomatic renal calyceal diverticular (CD) stones. A case series. Department of Urology, Hisar Intercontinental Hospital, from 2008 and 2019. Patients who underwent holmium laser lithotripsy with RIRS to manage symptomatic CD stones were evaluated retrospectively. Demographics, stone size, operation and hospital stay duration, the success of treatment and complications were noted. Among the 30 treated patients, 13 patients were female and 17 were male. The mean age was 45.4 ± 11.9 (26-64), the stone diameter was 14.4 ± 4.1 mm, operation time was 70.47±35.7 (35-155) minutes, and mean length of hospital stay was 1.27±0.5 (1-3) days. In those patients who underwent RIRS, 26 (86.7%) were successfully treated while in 4 of 30 patients (13.3%) the procedure was not successful. Complications were observed in 10 (33.3%) patients. Clavien-I complications were demonstrated in 6 patients, Clavien III complications were demonstrated in 3 patients. One patient had urosepsis, 2 patients had ureteral laceration, and one patient with Clavien IV complication had perirenal hematoma. Laser lithotripsy therapy with RIRS is a safe and effective treatment for symptomatic calyceal diverticular stones and can be offered as the first-line treatment for calyceal diverticular stones. Calyceal diverticula, Stone disease, Flexible ureterorenoscopy, Holmium laser, RIRS.

V17 - Upper pole calyceal diverticulum treated by miniperc in the supine position: Step-by-step technique

V17 - Upper pole calyceal diverticulum treated by miniperc in the supine position: Step-by-step technique

Calyceal diverticula: Clinical, radiological and histopathological findings of an uncommon entity with presumed congenital origin

Calyceal diverticula (CD) are relatively uncommon urologic conditions that generally follow an asymptomatic course and rarely require medical intervention. CD are thought to have a congenital origin due to abnormalities during the process of ureteral bud formation. Clinically and radiologically, they can mimic multiple neoplastic and non-neoplastic renal processes, with potentially relevant differences in the management of these patients. Symptoms are usually associated with the presence of stones, obstruction to the drainage of the diverticulum, large size, or secondary infection. In chronic cases, surgery might become necessary, creating an opportunity to examine the histopathological characteristics of this condition. Although these are benign in the majority of patients, some rare instances of malignancy arising from the CD have been reported. In this series, we addressed the clinical, radiological, and histopathological findings of CD.

A case report of renal calyceal diverticulum with hypertension in children and review of literature

BackgroundRenal calyx diverticulum refers to a cystic lesion covered with the transitional epithelium in the renal parenchyma. Although there is no clear evidence that calyx diverticulum can cause hypertension, there exists a close association between the two, and there are few related reports. Herein, we reported the case of a child with renal calyx diverticulum complicated with hypertension and summarized the diagnosis and treatment.Case presentationPhysical examination of the patient, an 11-year-old child, revealed a left renal cyst with hypertension (155/116 mmHg). There were no related symptoms. Routine urine and blood biochemical examinations showed no abnormalities. Imaging revealed left renal cyst compression causing the hypertension. She underwent renal cyst fluid aspiration and injection of a sclerosing agent into the capsule, but her blood pressure increased again 3 days postoperatively. Color Doppler ultrasonography showed that the size of the left renal cyst was the same as that preoperatively. To further confirm the diagnosis, cystoscopic retrograde ureteropyelography was performed to confirm the diagnosis of renal calyx diverticulum. Subsequently, renal calyceal diverticulum resection and calyx neck enlargement were performed. The operation went smoothly and the blood pressure returned to normal postoperatively. No abnormalities were noted at the 7-month postoperative follow-up.ConclusionThere exists an association between renal calyx diverticulum and hypertension. Therefore, hypertension can be considered a surgical indication for renal calyx diverticulum. Moreover, renal calyceal diverticulum in children can be easily misdiagnosed as a renal cyst. Therefore, it is important to be vigilant to prevent a series of complications, such as postoperative urine leakage, in such cases.

The Clinical Efficacy of Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of Calyceal Diverticulum Stones: A Meta-Analysis

Background: The clinical efficacy of percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of calyceal diverticulum stones (CDs) remains controversial. We performed a meta-analysis to assess the clinical efficacy of PCNL and FURL in the treatment of CDs. Methods: We searched a number of relevant electronic databases including China National Knowledge Infrastructure (CNKI), MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until January 31, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of these studies was assessed by the Newcastle-Ottawa Scale (ranged from 0 to 9 stars). Results: Finally, we selected 11 high-quality studies in our meta-analysis,which containing 486 patients. Meta-analysis showed that PCNL had higher stone-free rate [OR=3.55, 95% CI: 2.07 -6.10, P = 0.000], symptom-free rate [OR=3.56, 95% CI: 1.51 -8.38, p= 0.004], while it was slightly inferior to the FURL in bleeding volume [SMD = 1.27, 95% CI: (0.67,1.87), P = 0.000], hospital stay [SMD =2.86, 95% CI: 1.75-3.97, P = 0.000] and complication rate [OR =1.92, 95% CI: 1.10-3.33, P = 0.021], and there was no significant difference in operative time [SMD = -0.011, 95% CI: (-0.41,0.39), P = 0.957]. Conclusion: PCNL is safe and effective in the treatment of CDs, which can be considered as the first choice for the clinical treatment of CDs.

Flexible Ureteroscopic Holmium Laser Infundibulotomy and Lithotrypsy for the Management of Calyceal Diverticular Stone with Infundibular Atresia: A Case Report

Renal calyceal diverticulum is a non-secretary urothelium cavity in the renal parenchyma communicating with calyx allowing for passive filling with urine. Calyceal diverticula are found incidentally in 0.21% to 0.6% of intravenous urograms in adults. Stone formation occurs in about 10-50% cases of renal calyceal diverticula. Symptomatic case needs treatment. Digital flexible ureteroscopy with Holmium laser infundibulotomy and laser lithotripsy is beneficial in terms of shorter hospital stay, better stone clearance and minimal complications in comparison with those of other modalities. Cases of stenotic infundibulum have been addressed adequately but infundibular atresia has been rarely reported. Therefore, we present a symptomatic case of calyceal diverticular stone with infundibular atresia managed by disposable flexible ureteroscopy with holimium laser infundibulotomy and laser lithotripsy.

Supine PCNL-5 year experience in a tertiary care center.

The prone position for percutaneous nephrolithomy (PCNL) has been widely practiced. There has been a shift from prone position to supine position which showed numerous benefits. The aim of our study is to describe the 5 year experience from the perspective of a tertiary care center using a modified Galdakao supine Valdivia position for total tubeless ultra mini supine PCNL, total tubeless supine PCNL, tubeless supine PCNL, and standard supine PCNL. We retrospectively reviewed the data of 90 patients who underwent supine PCNL at the tertiary care center during the period of 5 years from January 2017 to January 2021. The data collection was done from patients' medical records. Pre operatively, complete examination of the patients with laboratory investigations were done. The modified Clavien classification system was used to classify the perioperative complications of PCNL. Operative time was lowest for ultra mini supine PCNL (50 ± 10.4 min) compared to standard supine PCNL (58 ± 11.2 min). Stones were single in 54 patients and multiple in 40 patients with 4 patients with staghorn stones. The size of the stones in the largest dimension ranged from 1.2 to 5.5 cm.Complete clearance was achieved in 84 (89.7%) patients. Seven patients (7.2%) developed mild fever and four patients (4.5%) required blood transfusion. We found supine PCNL to be an immensely convenient, time-saving practice, and with higher stone free rate compared to prone PCNL. The different techniques of supine PCNL were also useful in patients with horseshoe kidney and calyceal diverticulum which resulted in good outcomes in these patients.

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

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 ...