Abstract:Objective To compare the efficacy and safety of visual needle percutaneous nephrolithotomy (V-PCNL) and flexible ureteroscopy (F-URS) in the treatment of calyceal diverticular calculi. Methods A retrospective analysis was performed on the clinical data of 18 patients (7 males and 11 females) who underwent V-PCNL (V-PCNL group,n=9) and F-URS (F-URS group,n=9) from April 2018 to July 2020.The data on patient age,gender,BMI,stone size,diverticulum location and preoperative urinary tract infection were collected.The operative time,postoperative hospital stay,visual analogue scale (VAS) score,stone clearance rate,postoperative symptom relief rate and complication rate were compared between two groups. Results There were no statistical differences of baseline data between two groups (all P>0.05).The operations were successfully completed in 18 patients.After no diverticulum orifice was found in 2 cases by flexible ureteroscopy,they were transferred to V-PCNL group to complete the lithotripsy successfully.In F-URS group,lithotripsy was completed in the second-stage in 1 case because of intraoperative diverticulum bleeding during the first-stage surgery.There were no significant differences in average operation time,postoperative symptom remission rate,postoperative residual calculus rate and postoperative complications rate between two groups(all P>0.05).However,VAS score［(2.00±1.00)vs(3.56±1.13),P<0.01］ and postoperative hospital stay［(2.33±1.00)d vs(5.44±1.01)d,P<0.01］in F-URS group were superior to those in V-PCNL group. Conclusion In the treatment of calyceal diverticular calculi,F-URS can be considered as the first choice,and V-PCNL can be a safe alternative method if F-URS fail to explore calyceal diverticulum.