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

Abstract

Our review clearly suggests an advantage of percutaneous management over ureteroscopy for complex posterior symptomatic caliceal diverticula, although with a slightly increased risk of complications. Therefore, PNL should be considered the primary modality for managing these difficult processes. In cases where the stenotic infundibulum cannot be traversed with a guidewire, creation of a neoinfundibulotomy permitted secure access to the collecting system while providing effective results.

Pre-percutaneous Nephrolithotomy Opacification for Caliceal Diverticular Calculi

“…The percutaneous approach has been reported to be associated with a better stoneand symptom-free outcome. 2 In most cases, access to the diverticular cavity is obtained under fluoroscopic guidance, a technique that requires a radiopaque target. Several groups have reported opacifying the diverticular cavity by instillation of contrast material through a ureteral catheter placed in retrograde fashion prior to PCNL.…”

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

“…We were successful in managing lower pole diverticulum ureteroscopically, unlike many reports that claim that the lower pole caliceal diverticula stone may not be conducive to ureteroscopic management. 21,22 To our knowledge, this is the largest series of stone-bearing caliceal diverticula that have been managed with F-URS holmium laser with long-term follow-up to 6 months to evaluate the presence or lack of symptoms. We believe that this procedure should be proposed as first-line therapy for stonebearing diverticula with moderate stone burden.…”

Endourological Re-Establishment of a Disrupted Infundibulum after Renal Laceration

“…Previously we reported transluminal re-canalization by needle puncture under fl uoroendoscopic control with complete obliteration after traumatic urethral disruption [2] . Only 2 reports have focused on neoinfundibulotomy [3,4] . When the stenotic infundibulum cannot be traversed with a guide wire, the creation of a new infundibulum will offer a secure alternative for accessing the collecting system.…”