Percutaneous management of renal caliceal diverticular stones: Ten-year experience of a tertiary care center with different techniques to deal with diverticula after stone extraction

Abstract

Introduction:Caliceal diverticulae are a frequent surgical problem. We present our experience with caliceal diverticular stones (CDS) managed with percutaneous nephrolithotomy (PCNL) and describe the two different techniques to deal with diverticula after stone retrieval.Materials and Methods:We retrospectively analyzed 10-year data of 44 consecutive patients who underwent PCNL for CDS. During PCNL, if the guide wire could be negoted through the neck of the diverticula, we dilated and stented it. If we couldnot find the neck, we fulgurated the diverticular walls. Follow-up included intravenous urogram at 3 months and annual plain films thereafter. We analyzed the outcome, complications, and recurrence rate.Results:Total stone clearance was obtained in 40 (90.90%) patients. We dilated and stented the diverticula in 35 (79.5%) patients and fulgurated the walls in nine (20.5%) patients. Complications occurred in three patients. The postoperative intravenous urogram showed obliteration of diverticula in seven patients and the improved drainage in 37 patients. At the average follow-up of 2 years, 41 (93.18%) patients were asymptomatic and two (4.5%) patients showed the recurrence of stone.Conclusions:PCNL can clear calculi from caliceal diverticula in most cases with minimal morbidity. After stone retrieval, the diverticula may be drained into the pyelocaliceal system, if the neck is negotiable and fulgurated if the neck cannot be dilated.

Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi

“…Surgical time for PCNL-treated calyceal diverticula was similar to previous reports. [5171926] Time for FURS in this study was similar to that reported by Sejiny et al . [2] (80–210 min, average 91 min), however, diverticular orifices in their study were in an open state, which enabled identification of the orifices.…”

Present indications and techniques of percutaneous nephrolithotomy: What the future holds?

“…[17] Review 4 221 PCNL Srivastava et al. [18] Retrospective 3b 44 PCNL Gücük and Üyetürk [19] Review 4 259 PCNL Zhang et al. [20] Meta-analysis 1a 2142 PCNL Siev et al.…”

“…PCNL remains effective in the management of upper-pole diverticula but carries the risk of pulmonary complications. In another study, it was reported that among management options for CDS, the most versatile approach with maximum stone-free and symptom-free rates is PCNL [18] . In this study, the stone clearance was more than 90% and the conclusion was that PCNL can clear calculi from calyceal diverticula in most cases with minimal morbidity.…”

“…In this study, the stone clearance was more than 90% and the conclusion was that PCNL can clear calculi from calyceal diverticula in most cases with minimal morbidity. After stone retrieval, the diverticula may be drained into the collecting system or fulgurated [18] .…”

Planning and Execution of Access for Percutaneous Renal Stone Removal in a Community Hospital Setting

“…These cases are very delicate. 12,13 The author's usual approach has been to start with a nephrostogram, so as to opacify the diverticulum and collecting system. However the diverticulum is targeted, an 18-gauge needle is used for puncture, because the needle has some directability once the tip is in the diverticulum and because of its stiffness it will not buckle in the tract.…”