Adam C Mues1, Jaime Landman, Mantu Gupta. 1. Department of Urology, Columbia University Medical Center, New York, New York 10032, USA. adammues@gmail.com
Abstract
BACKGROUND AND PURPOSE: Excluded calices refer to a single calix or multiple calices that are completely isolated from the collecting system. The etiology is a result of infection, malignancy, or inflammation that is secondary to endoscopic renal surgery. We report our experience with the endoscopic management of excluded calices. PATIENTS AND METHODS: We retrospectively reviewed the data for our patients with a diagnosis of excluded calices. Patients were treated with various endoscopic techniques, all necessitating the formation of a neoinfundibulum. Patients were evaluated for symptomatic and radiographic evidence of resolution. RESULTS: Eight patients were found to have excluded calices. Seven patients had a history of urolithiasis and previous endoscopic renal surgery. One patient had undergone a laparoscopic partial nephrectomy with a postoperative urinary fistula. Six of eight patients were treated with a percutaneous approach followed by laser incision, balloon dilatation, or nephroureteral stent placement. Two objective failures occurred. One patient received re-treatment and has not demonstrated persistence or recurrence since the second procedure. No complications occurred as a result of endoscopic management. CONCLUSION: Excluded calices commonly result from inflammation from previous renal surgery. Goals of management include relief of obstruction, management of stones, and regaining continuity with the remaining collecting system. Successful treatment with endoscopic management involves creation of a neoinfundibulum and placement of a temporary ureteral stent.
BACKGROUND AND PURPOSE: Excluded calices refer to a single calix or multiple calices that are completely isolated from the collecting system. The etiology is a result of infection, malignancy, or inflammation that is secondary to endoscopic renal surgery. We report our experience with the endoscopic management of excluded calices. PATIENTS AND METHODS: We retrospectively reviewed the data for our patients with a diagnosis of excluded calices. Patients were treated with various endoscopic techniques, all necessitating the formation of a neoinfundibulum. Patients were evaluated for symptomatic and radiographic evidence of resolution. RESULTS: Eight patients were found to have excluded calices. Seven patients had a history of urolithiasis and previous endoscopic renal surgery. One patient had undergone a laparoscopic partial nephrectomy with a postoperative urinary fistula. Six of eight patients were treated with a percutaneous approach followed by laser incision, balloon dilatation, or nephroureteral stent placement. Two objective failures occurred. One patient received re-treatment and has not demonstrated persistence or recurrence since the second procedure. No complications occurred as a result of endoscopic management. CONCLUSION: Excluded calices commonly result from inflammation from previous renal surgery. Goals of management include relief of obstruction, management of stones, and regaining continuity with the remaining collecting system. Successful treatment with endoscopic management involves creation of a neoinfundibulum and placement of a temporary ureteral stent.