Management of calyceal diverticular stones with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy: long‐term outcome

Abstract

OBJECTIVETo review patients with an extended followup after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) for calyceal diverticular stones (CDS), over a 15-year period, assessing the longterm outcome. PATIENTS AND METHODSIn all, 56 patients were treated for symptomatic CDS disease by ESWL (38) or PCNL (18). The stone-bearing diverticula were in the upper calyces in 26, middle calyces in 24 and lower calyces in six patients, and in the right kidney in 22 and in the left in 34. The most frequent symptom was ipsilateral flank pain (84%) and 32% of patients presented with associated chronic urinary tract infections. In a retrospective analysis, we assessed stone size, diverticulum location, stone-free rate, symptom-free rate, complications and extended follow-up. RESULTSIn the short-term in the ESWL group, 21% of patients were stone-free and 61% were asymptomatic; 8% developed symptoms and 8% developed recurrence or stone-growth in the long term. There were six minor complications. In the PCNL group, 15 patients (83%) were stone-free in the short term; two had a recurrence (11%) and two had stone growth (11) in the long term. There were three complications after PCNL. CONCLUSIONSThis series shows that PCNL is an effective and durable means of treating CDS, regardless of stone size or location of the diverticulum. Despite low stone-free rates with ESWL, most patients were rendered symptom-free with minimal complications. The long-term recurrence rates, 8% for ESWL and 11% for PCNL, were comparable.

Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

“…Larger renal calculi (>2 cm) have historically been treated with percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL) or a combination thereof [1][2][3]. PCNL is regarded as the gold standard treatment for larger stones with a clearance rate of 77 to 95 % [1-4, 7, 8].…”

Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters

“…SWL is generally not recommended in patients with a calculus in a calyceal diverticulum. While some patients may have symptomatic relief with stone fragmentation, stone-free rate is only 21% because the diverticular neck does not allow for stone passage [32] . If the ostium of the diverticulum is well-visualized, the stone is small, and the diverticula fills with contrast, success rates have been shown to be improved [33] .…”

Retrograde intrarenal surgery in the management of symptomatic calyceal diverticular stones: a single center experience

“…Despite PCNL having the higher stone-free rate (>90 %), percutaneous management of the calyceal diverticular stones is challenging because the space is usually narrow and identifying the diverticular neck is often difficult. In addition, it has a higher rate of complications compared with other modalities [18]. When the diverticulum is located anteriorly, which needs a tract that goes through more renal parenchyma and, hence, there is an increased risk of significant hemorrhage.…”