title: Management of stones associated with intrarenal stenosis: infundibular stenosis and caliceal diverticulum.
abstract: OBJECTIVE
  To review our experience with retrograde intrarenal surgery (RIRS) for management of conditions associated with intrarenal stricture and present a treatment algorithm based on the series.
  
  
  METHODS
  RIRS was offered to all patients with symptomatic intrarenal stenosis regardless of location if stone burden was 2 cm or less. With a combined endourology and lithotripsy table, patients with stones between 2 and 3 cm were also offered RIRS using a combined approach of RIRS and shockwave lithotripsy (SWL). A total of 108 patients with symptomatic stones and caliceal diverticulum or infundibular stenosis were included in the data analysis. A standard technique was used in all cases. Failures or patients not suitable for RIRS were treated with either percutaneous nephrolithotomy (PCNL) or laparoscopic surgery.
  
  
  RESULTS
  Successful identification and dilation/incision of the stenotic opening was accomplished in 94% of cases. Seventy-five percent of stones were managed with basketing and/or holmium laser ablation. In these patients, 90% were stone free (<2 mm stone fragments). For stones between 2 and 3 cm, the use of holmium laser in combination with SWL provided stone-free rates of 75%. Five percent of patients needed PCNL because of larger stone burden and posterior location.
  
  
  CONCLUSIONS
  With the appropriate equipment, RIRS provides a valid treatment option for patients with intrarenal strictures. While upper pole and midrenal lesions are ideal, lower pole segments may be approached as well. A treatment algorithm based on the results provides a simplified approach for the minimally invasive management of intrarenal stenosis.
authors.affiliation: Department of Urology, Cedars-Sinai , Los Angeles, California.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Koopman
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fuchs
mesh_terms: D000465:Algorithms; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D004240:Diverticulum / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007674:Kidney Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008096:Lithotripsy / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014567:Urography