Amy E Krambeck1, James E Lingeman. 1. Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana, USA.
Abstract
BACKGROUND AND PURPOSE: Caliceal diverticula are rare congenital abnormalities that can become symptomatic if associated with a calculus or infection. We review percutaneous management of caliceal diverticula. METHODS: Pathogenesis, clinical evaluation, management options, and recommended follow-up for symptomatic caliceal diverticula are reviewed. We present our single-stage and prepercutaneous nephrolithotomy opacification techniques for the management of caliceal diverticula. This involves complete extraction of all stone particles and ablation of the diverticular cavity without infundibular identification or dilation. Comparison of outcomes between our current ablative technique and our previous dilation technique is evaluated. RESULTS: Percutaneous management of caliceal diverticula offers the highest symptomatic relief and stone-free rate of available management options. We identified 106 patients with caliceal diverticula who were treated with a percutaneous approach. Review of 85 of these patients demonstrated that most procedures can be performed with a small nephrostomy tube in place for 24 hours and an overnight hospital stay. Minimal complication and stone recurrence rates were observed. Patients treated with caliceal diverticular ablation experienced a shorter hospital stay, fewer complications, and a higher stone-free status than those patients who were treated with dilation of the diverticular infundibulum. CONCLUSIONS: Percutaneous management of caliceal diverticula using cavity ablation is a minimally invasive technique that offers long-term symptomatic relief with minimal complications.
BACKGROUND AND PURPOSE: Caliceal diverticula are rare congenital abnormalities that can become symptomatic if associated with a calculus or infection. We review percutaneous management of caliceal diverticula. METHODS: Pathogenesis, clinical evaluation, management options, and recommended follow-up for symptomatic caliceal diverticula are reviewed. We present our single-stage and prepercutaneous nephrolithotomy opacification techniques for the management of caliceal diverticula. This involves complete extraction of all stone particles and ablation of the diverticular cavity without infundibular identification or dilation. Comparison of outcomes between our current ablative technique and our previous dilation technique is evaluated. RESULTS: Percutaneous management of caliceal diverticula offers the highest symptomatic relief and stone-free rate of available management options. We identified 106 patients with caliceal diverticula who were treated with a percutaneous approach. Review of 85 of these patients demonstrated that most procedures can be performed with a small nephrostomy tube in place for 24 hours and an overnight hospital stay. Minimal complication and stone recurrence rates were observed. Patients treated with caliceal diverticular ablation experienced a shorter hospital stay, fewer complications, and a higher stone-free status than those patients who were treated with dilation of the diverticular infundibulum. CONCLUSIONS: Percutaneous management of caliceal diverticula using cavity ablation is a minimally invasive technique that offers long-term symptomatic relief with minimal complications.