Percutaneous management of caliceal diverticular calculi: Technique and outcome

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.