[Management of lithiasis associated with intrarrenal stenosis using the flexible videoureteroroscope.]

Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard.

We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were less than 2 mm on CT Scan one month after procedure.

Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%.

Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of less perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery.