calyceal diverticulum with stone MINIPERC + LASER LITHOTRIPSY скачать в хорошем качестве

calyceal diverticulum with stone MINIPERC + LASER LITHOTRIPSY

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Current modifications of PCNL include mini PCNL, ultramini PCNL, and micro PCNL. Mini PCNL utilises a smaller percutaneous access with sheath sizes between 15Fr and 24Fr. One benefit of this technique is that it allows the use of a flexible nephroscope compared to the other minimally invasive PCNL techniques. Ultramini PCNL has evolved as another technique in the endourologist’s armamentarium [12]. Ultramini PCNL uses a 6F inner sheath and 13F outer sheath that accommodates a 3.5F miniature nephroscope. Stones are fragmented with laser, and a side channel is used for irrigation of saline that produces an eddy current to evacuate the fragments using the vortex effect [10]. Further miniaturisation using micro-PCNL is a technique demonstrated by Bader et al. using a 0.9mm diameter micro-optical needle connected to a light source to perform a puncture allowing the whole PCNL to be done through a tract of 4.85Fr with laser stone fragmentation of the stones  flexible is effective for anteriorly located or mid-upper pole diverticular calculi, but it is limited by difficulties in identification of the ostium. The calyceal diverticular neck can be widened using holmium laser incision which can give good long-term results and low retreatment rates