陳永泰, 陳日昇, 陳欣宏, 王俊凱
臺安醫院 臺大醫院 郵政醫院 泌尿科
The Diversity of the Anatomical Structure of the Infundibulum of Renal Diverticulum-The Experience of Flexible Ureterorenoscopic Exam
Yung-Tai Chen1,2,, Jih Sheng Chen1, Shin-Hong Chen1, Jun-Kai Wang1
Department of Urology, Taiwan Adventist Hospital１, National Taiwan University Hospital２
To report on our result of examining the anatomical structure of the infundibulum of renal diverticulum during treatment of renal diverticular stone.
Materials and Methods:
A total of 16 cases of renal diverticular stone as diagnosed by intravenous urography. The female to male ratio is 12:4. The lesion was more at the right side, right to left ratio is 9:7. The age ranges from 19-58 years old. All patients underwent flexible ureterorenoscopic examination and treatment of renal diverticular stone. The scope used is a Olympus type V flexible ureterorenscope with magnification power of 50x. The whole renal pelvicaliceal system was examined to identify the location and anatomical structure of the opening of the renal diverticulum. All procedures were performed under the assistance of a mobile C arm fluoroscope. If the opening is not found by flexible ureterorenoscopy, retrograde injection of contrast medium was performed to help identify the opening. If the opening is noted, it was enlarged by holmium YAG laser incision. The diverticular stones were crushed by laser then stone fragments were removed by stone basket.
The opening of renal diverticulum was found in 14 cases while completely obliteration of opening was noted in 2 cases. In 12 cases the opening is pinpoint like which allows only a 200 micron laser fiber to pass it. In one case, the opening was constituted by a broad semitransparent membrane. The last case has a wide and patent opening which allows the type V Olympus flexible ureterorenoscope to pass it though preoperative intravenous urography could not show the opening. Stone free rate was 91.6% in the 12 cases whose opening of renal diverticulum could be found.
Preoperative intravenous urography cannot demonstrate the anatomical structure of the renal diverticular opening. The anatomical structure is diverse rather than uniform. Flexible ureterorenoscopy is a useful tool in both identifying the structure of renal diverticular opening and treatment of renal diverticular stone.