Calcul géant compliquant un diverticule caliciel

Calyceal diverticulum is acystic cavity in the renal parenchyma, communicating with the collecting system via an infundibulum. In more than 40% of cases it is associated with a stone and in most cases appears as milk of calcium forming a fluid level or multiple small stones. We here report the case of an 82-year old patient with no previous history, presenting with mild and intermittent right flank pain lasting for 8 years. Clinical examination was normal. The patient first underwent X-ray of urinary tree without preparation showing a density of calcium projecting into the upper pole of the right kidney (A). The patient then underwent uroscanner showing giant stone measuring 28mm within a caliciel diverticulum of the upper pole directly communicating with the renal pelvis (B). No associated urinary tract infection or haematuria were detected. Given patient's age and that he was paucisymptomatic and uninfected, therapeutic abstention and monitoring were indicated. In accordance with the recommendations of the experts, only symptomatic intradiverticular stones must be treated. First, extracorporeal shockwave lithotripsy (ESWL) allows improvement to the symptoms in 1 patient out of 2 and no stone fragmentation in 1 patient out of 4. In second intention, flexible uretero-renoscopy should be performed. Percutaneous nephrolithotomy can be performed if the stone is located in the lower pole (rare). Finally, in case of failure, laparoscopic treatment or open surgery may be proposed.