# Renal artery pseudoaneurysm following holmium laser diverticular neck incision for calyceal diverticular stones: a rare case report

## TL;DR

A rare case of a kidney artery injury following a minimally invasive stone treatment is reported, emphasizing the need for vigilance in managing such complications.

## Contribution

This case report documents a rare vascular complication following fURSL for calyceal diverticular stones.

## Key findings

- A 29-year-old patient developed a renal artery pseudoaneurysm after fURSL for a calyceal diverticular stone.
- Transcatheter arterial embolization successfully resolved the pseudoaneurysm and bleeding.
- Delayed hematuria following fURSL should prompt early angiographic evaluation for potential vascular injury.

## Abstract

Calyceal diverticulum (CD) is a rare congenital anomaly that predisposes patients to stone formation due to impaired urinary drainage. Flexible ureteroscopy with holmium laser incision of the diverticular neck followed by holmium laser lithotripsy for the associated calculi, particularly when combined with a suction-assisted ureteral access sheath, is a favored minimally invasive approach for managing calyceal diverticular stones. While generally safe, vascular complications are exceptionally rare and potentially life-threatening.

We report a rare case involving a 29-year-old man with an upper pole calyceal diverticular stone, who underwent successful fURSL with laser incision of the diverticular neck and complete stone clearance using a suction-assisted access sheath. Five days postoperatively, the patient presented with gross hematuria and flank pain. Conservative management failed, and angiography identified a pseudoaneurysm in an upper-pole branch of the left renal artery. Transcatheter arterial embolization (TAE) was performed, leading to complete resolution of the pseudoaneurysm and bleeding.

This case highlights a rare but serious vascular complication of fURSL in patients with narrow neck calyceal diverticula. Surgeons should be aware of the risks of vascular trauma and consider early angiographic evaluation in the setting of delayed hematuria.