Objective: Symptomatic renal calculi found within caliceal diverticula are
difficult to treat. We present a single-surgeon cohort of 21 consecutive pa
tients undergoing percutaneous treatment of stones within caliceal divertic
ula over a 12-year period.
Patients and Methods: Each patient was managed by a one-stage percutaneous
nephrolithotomy (PCNL). The majority of diverticula were situated at the up
per pole. Access was gained via a direct target puncture, a Y puncture from
a parallel calix, or through the diverticular stalk in the neighboring cal
ix. The approach was commonly supracostal. A single-stage dilator was used
to establish the track. Stones were removed intact or fragmented with ultra
sonic lithotripsy, and the diverticular necks were treated with endoscopic
division or dilation and splinted with a 22F nephrostomy tube for several d
ays.
Results: Total stone clearance was obtained by PCNL alone in 95% of cases.
The only case with incomplete clearance was cleared successfully with shock
wave lithotripsy (SWL). Twenty patients were assessed with an intravenous u
rogram at 3 months and then annual plain films and clinical assessment. Fur
ther imaging was performed in selected cases. The diverticula were oblitera
ted or had improved drainage in 85% of assessable cases. Three patients dev
eloped recurrent stones and were treated with SWL, laparoscopic diverticule
ctomy, on partial nephrectomy. One further patient required partial nephrec
tomy for poor drainage and ongoing pain. Of the 21 patients, 17 have remain
ed stone, symptom, and infection free with clinical and radiologic follow-u
p ranging from 6 months to 12 years.
Conclusions: This series demonstrates that percutaneous surgery can clear c
alculi from caliceal diverticula and, in most cases, correct or remove the
underlying anatomic abnormality.