Pre-percutaneous Nephrolithotomy Opacification for Caliceal Diverticular Calculi

Abstract

Caliceal diverticula harbor calculi in as many as 50% of cases. Such stones rarely pass spontaneously. Various stone-removal techniques have been used, with percutaneous techniques generally having the best results. In patients with nonradiopaque stones or in whom the diverticulum does not opacify when contrast is instilled retrograde or by intravenous urogram, contrast can be instilled directly into the cavity with CT or ultrasound guidance. Three such cases are described, with good results.

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

“…Researches of PCNL treatment for stone-bearing calyceal diverticula suggest that stone-free rates are 70-100 %, with recurrence rates of 0-30 % [6,[12][13][14][15][16][17]. 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.…”

Percutaneous Management of Caliceal Diverticuli

“…The opacification will occur later in the examination, because the diverticulum is filled in a retrograde fashion from the calix or renal pelvis and thus delayed images are necessary. 16 A retrograde pyelogram can be helpful in determining where the neck of the diverticulum is located. If the neck or infundibulum is obstructed, the diverticulum will not opacify.…”

“…With technologic advancements, the treatment has become progressively less invasive. Currently used minimally invasive treatment for patients with symptomatic caliceal diverticula includes shockwave lithotripsy (SWL), [17][18][19] ureteroscopy (URS), [20][21][22][23] percutaneous nephrolithotomy (PCNL), 16,17,20,[24][25][26][27][28][29][30] and laparoscopy. [31][32][33][34][35][36] SWL for the management of caliceal diverticula is an attractive but controversial minimally invasive treatment option.…”

“…16,17,25,26,[28][29][30] More than 90% of patients report symptomatic relief with percutaneous treatment, 17,20,25-28 and long-term studies have demonstrated these results to be durable. 28 In most cases, percutaneous access is directly onto the caliceal diverticulum, because it allows use of a rigid nephroscope.…”

“…42 Unfortunately, it is difficult to monitor the guidewire manipulation with US imaging. Matlaga and associates 16 have described CT or US guided pre-PCNL opacification of the caliceal diverticulum as an alternative approach. Opacification of the diverticulum by interventional radiology provides the necessary target for percutaneous access in the operating room.…”