Management of renal caliceal diverticular stones: A decade of experience

Abstract

Objective:The objective of this study is to evaluate our methods for management of renal caliceal diverticular stones (CDS).Materials and Methods:We conducted a retrospective study from January 2005 to July 2015 and included patients who were treated for renal CDS. Patients were evaluated for treatment modality, puncture site (in case percutaneous nephrolithotomy [PCNL] attempted), operative time, stone clearance rate, and complications. During PCNL, if the infundibulum was found to connect the diverticulum to the calyx, then a double J stent was placed. No attempt was made to dilate the diverticular neck or to create a neoinfundibulum.Results:Twenty-four patients were treated for CDS during the study period. Two patients underwent shockwave lithotripsy, and 22 were managed by PCNL. Mean stone size was 16.37 mm (range: 6–35 mm) and mean diverticulum size was 20.62 mm (range: 12–37 mm). No fulguration was done in initial 17 patients, while fulguration by Holmium Laser was performed in the last five cases treated with PCNL. Mean operative time was 70.31 min (range: 47–90 min). Mean follow-up was 34 months, diverticulum resolved in 14 patients and reduced in size in 7 patients.Conclusion:Caliceal diverticular calculi can be treated most efficiently by PCNL. Stone-guided puncture and no attempt to dilate or create neoinfundibulum reduces operative time and morbidity while yielding high stone-free rate.

Supine Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon’s Experience

“…In our study, the bull's eye technique has proved superior in such scenarios with better access, stone clearance rate, and a lesser number of punctures. In a study on management of calyceal stones by Patodia et al, they concluded that stone-guided puncture without dilation or creation of neo-infundibulum reduced operative time and morbidity with higher stone-free rate [ 7 ]. As compared to the supine, the prone position has a significantly shorter nephrostomy tract length and more potential access sites that provides ease and safety of percutaneous renal access [ 8 ].…”

Calyceal diverticular stones: Does the insistence on less invasive technique keep the patient away from a major complication?

“…In general, PCNL is preferred for such stones to achieve a stone-free status, particularly for a large diverticulum with a large stone burden [4]. Although, PCNL is more invasive than ureteroscopy (URS), it has the highest stone -and symptomfree rates (>90%) [5]. The reported incidence rates of infectious complications following PCNL are as follows: bacteremia 23%; endotoxemia 34%; fever 25%; and septic shock 0.3 to 2.5% [4].…”