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 ± 17.4 years 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 ± 0.8 g/dL. The average operation time was 57.5 ± 17.4 min, and the mean hospital stay was 3.5 ± 1.4 days. A complete resolution of CD was observed in five (41.7%) patients over the average follow-up of 10.8 months. In terms of the all-seeing needle-assisted PCNL, the average operation time was 83.5 ± 32.4 min, and the mean hospital stay was 4.38 ± 2.25 days. The SCR reached 91.7%, and the blood loss was 1.7 ± 1.1 g/dL. Nine patients (75%) were observed to have complete CD resolution over an average of 12.2 months 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.