The first experience in retrograde intrarenal surgery for treating calyceal diverticula in children

BACKGROUND: A calyceal diverticulum is quite a rare pathology in children. It also poses diagnostic challenges for physicians. The incidence of calyceal diverticula ranges from 3.3 to 4 cases per 1000 children. The gold standard for its diagnostics is computed tomography with intravenous contrast. All diverticula with dimensions exceeding 2.5 cm or more are subject to surgical treatment due to the risk of developing urinary tract infection, pain and possible stone formation. A modern and promising management technique in such patients is retrograde intrarenal surgery.

The article presents the first Russian experience of application of retrograde intrarenal surgery for calyceal diverticula in children.

AIM: To assess the effectiveness of a new minimally invasive method of retrograde intrarenal surgery for treating patients with calyceal diverticula.

METHODS: The authors present their experience on application of retrograde intrarenal surgery for treating calyceal diverticula in 15 patients aged from 6 to 17 years who were admitted to the Department of Urology in N.F. Filatov State Clinical Hospital in Moscow during 2022–2024. All patients had a single diverticulum, and its size was ≥2.5 cm. In 14 children, diverticula were located in the small renal cup, and only in one child it was in the large cup. Preoperative examination included ultrasound and computed tomography with intravenous contrast to assess the communicative function with the renal collector system. Concrements in the diverticular cavity were seen in 6 patients. Surgery was done under endotracheal anesthesia.

RESULTS: All patients were discharged on the third postoperative day with satisfactory urine and blood test findings and without pain. The children were repeatedly hospitalized in 4 weeks so as to remove the stent and to assess the calyceal diverticulum size: in 9 cases—decreased size of the cystic cavity and no complaints; in 6 cases—repeated surgical intervention, probably due to the insufficient size of artificially created fistula at the stages of technique mastering; after the size of cystic cavity got smaller.

CONCLUSION: Retrograde intrarenal surgery is a minimally invasive, promising and effective technique for treating cystic kidney malformations which is being actively implemented by urologists in their practice.