title: Efficacy of flexible ureterorenoscopy with holmium laser in the management of stone-bearing caliceal diverticula.
abstract: OBJECTIVE
  We aim to evaluate the outcome of flexible ureterorenoscopy (F-URS) with a holmium laser in managing stone-bearing caliceal diverticula as a minimally invasive option.
  
  
  METHODS
  We retrospectively reviewed the records of 38 patients who underwent F-URS using a holmium laser from 2003 to 2009 for symptomatic stone-bearing caliceal diverticula. The presenting symptoms were renal colic, urinary tract infection, or hematuria. F-URS was used in 30 (78.9%) patients as an alternative after the failure of shockwave lithotropsy (SWL). F-URS was repeated twice for two patients. In the first patient, the indication was uncompleted fragmentation of the stone. In the second patient, it was because of failure to identify the diverticulum. The follow-up visit ranged from 4 to 6 weeks with plain radiography of the kidneys, ureters, and bladder and either renal ultrasonography or noncontrast CT.
  
  
  RESULTS
  Patients who were included in the study were 38: 22 women and 16 men (mean age 45.7 years; range 18-72 years). Post-F-URS, 21 (55.3%) patients were rendered stone free (SF), 10 (26.3%) patients had clinically insignificant residual fragments (less than 4 mm) (CIRF), and a residual fragment (RF) was found in seven (18.4%) patients. The success rate was considered as SF or CIRF, which was obtained in 31 (81.6%) patients. In total, 34 (90%) patients were symptom free after the procedure.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Urology Department, Tenon Hospital, Pierre & Marie Curie University, Paris, France.
authors.forename: Majed
authors.initials: M
authors.lastname: Sejiny
authors.forename: Saeed
authors.initials: S
authors.lastname: Al-Qahtani
authors.forename: Abdel
authors.initials: A
authors.lastname: Elhaous
authors.forename: Benoit
authors.initials: B
authors.lastname: Molimard
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003710:Demography; D004240:Diverticulum / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D007670:Kidney Calices / Q000000981:diagnostic imaging / Q000601:surgery*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018583:Pliability; D011859:Radiography; D017211:Treatment Failure; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging; D018666:Ureteroscopy / Q000379:methods*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D055815:Young Adult