Endourologic Management for Calyceal Diverticular Stone

You, Dal san; Park, Tae han; Park, Hyung Keun

Abstract

PURPOSE: A symptomatic renal calyceal diverticular stone is a rare occurrence. Endourologic techniques, including laparoscopy, retrograde ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL) have been used for the treatment of this disease. Herein, we reviewed our experiences of treating stones in calyceal diverticulum with URS or PNL.
MATERIALS AND METHODS
We retrospectively reviewed 23 patients who underwent PNL (12 cases) or URS (11 cases) for the treatment of symptomatic calyceal diverticular stones. A direct target puncture of the diverticulum was made in the PNL group and a flexible or semi-rigid ureteroscope was used to reach the diverticulum in the URS group. The diverticular neck was either incised with Holmium:YAG laser or dilated. Extracorporeal shockwave lithotripsy (ESWL) was performed prior to the procedure in 9 of the 23 cases (2 in the PNL group and 7 in the URS group).
RESULTS
A complete stone-free state, with symptomatic resolution, was obtained in 11 of the 12 in the PNL group and in 7 of the 11 in the URS group. Success in the PNL group depended on an accurate puncture into the diverticulum and successful placement of the nephrostomy catheter into the renal pelvis through the diverticular neck. Success with the URS was achieved when the ureteroscope passed into the diverticulum and the double-J stent had been optimally placed. Seven of the 9 cases with prior ESWL achieved a stone-free state, while all the prior ESWL cases with successful access achieved a stone-free state.
CONCLUSIONS
A calyceal diverticular stone can be treated with PNL or URS in most cases, although they are technically challenging procedures. In both procedures, access into the diverticulum is the most important step for a successful outcome. If access can be gained, preoperative ESWL could facilitate clearance of the stone and reduce the operating time, as there is no need for intraoperative lithotripsy.