ArticleFrontiers in surgery2026
Clinical exploration of flexible ureteroscopy combined with holmium laser and intraoperative ultrasound localization for the treatment of stones in non-communicating calyceal diverticula: a single case report.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the value of intraoperative multimodal localization strategies in managing non-communicating calyceal diverticulum stones without preoperative definitive diagnosis in a single clinical case. Methods: A 48-year-old female with a history of open renal stone surgery and cesarean section was enrolled in this single case study. Preoperative CT revealed a calcified lesion (1.5 × 1.2 cm, CT value 1,235 HU) at the right upper renal pole but failed to identify the diverticular structure. Intraoperative exploration identified a ureteral orifice ectopically located on the right posterior bladder wall (23 mm deviation from midline). An innovative "three-step localization protocol" was implemented: 1. CT-anatomical landmark spatial co-registration, 2. Guidewire advancement with tactile feedback validation, 3. Real-time ultrasonographic confirmation of guidewire tip positioning. A 10/12Fr ureteral access sheath was pre-placed in the right ureter to establish a stable operative channel, facilitate irrigation and suction, and reduce ureteral mucosal injury during the surgical procedure. Diverticular neck incision was performed using holmium laser (200 μm fiber, 0.8J/20 Hz) for channel creation, followed by stone fragmentation under negative-pressure suction system guidance. Results: The procedure was completed in 90 min with negligible blood loss (<10 mL). Intraoperative ultrasonography confirmed complete stone clearance. No postoperative complications or recurrence was observed during follow-up. Conclusion: Multimodal localization technique achieved effective and precise surgical navigation for the non-communicating calyceal diverticulum in this single case. This approach combines the advantages of natural orifice preservation with controlled infection risk and minimized hemorrhagic complications, and may provide a valuable clinical and technical reference for cases with atypical anatomy and inconclusive preoperative imaging.
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