Endoscopic Management of the Symptomatic Caliceal Diverticular Calculus

Abstract

Caliceal diverticular calculi are most often asymptomatic and of little clinical significance. In certain cases they may be associated with flank pain, pyuria and chronic urinary tract infections. Treatment has evolved from open surgical techniques to a purely endoscopic approach. Percutaneous techniques are frequently used to address the diverticular stone burden and to dilate the diverticular neck, improving drainage. Small volume caliceal diverticular calculi and those in the anterior portion of the collecting system represent a greater technical challenge to the endoscopist. We describe a purely retrograde endoscopic technique for treating small stone burdens trapped in caliceal diverticula. Flexible ureteroscopy combined with 3F dilating balloons passed through the endoscopic working channel facilitated treatment. This retrograde technique was combined with a simultaneous primary percutaneous puncture into the diverticulum to treat larger stone burdens and calculi within long-necked diverticula. This combination facilitated prompt, through and through access of a percutaneously placed guide wire, increasing the overall efficiency of treatment. In conclusion, a retrograde endoscopic technique using the actively deflectable, flexible ureteroscope can successfully treat certain caliceal diverticular calculi. By combining this technique with a simultaneous percutaneous puncture, caliceal diverticular calculi throughout the collecting system may be cleared expeditiously.

Endoscopic Management of Symptomatic Caliceal Diverticula: A Retrospective Comparison of Percutaneous Nephrolithotripsy and Ureteroscopy

“…This combined approach has reduced operative times compared with URS monotherapy. 21 Ureteroscopy may be an appropriate initial treatment option for patients with a small stone burden in a midrenal or upper pole diverticulum, especially if the diverticulum is anteriorly located. As with our patient population undergoing URS, the majority of diverticula were located in the upper or middle portion of the affected kidney, optimizing the chances for a successful outcome.…”

Efficacy of Flexible Ureterorenoscopy with Holmium Laser in the Management of Stone-Bearing Caliceal Diverticula

“…Grasso and associates 19 also reported successful management of certain cases of caliceal diverticula calculi and the need for simultaneous percutaneous puncture in others. 19 Nevertheless, the subsequent modifications in the mechanical workings of the actively deflectable F-URS, especially the second-generation type, have increased its therapeutic potential, allowing us to obtain the best outcome (Fig. 2).…”

Percutaneous Endoscopic Treatment for Calyceal Diverticular Calculi

“…In such cases, using a flexible ureteroscope, the diverticular neck may be visualized directly, and a guide wire may be passed through the infundibulum and into the diverticular cavity [15]. Although this procedure is less invasive than percutaneous management, it may be technically challenging to those with limited experience using flexible ureterorenoscopy.…”