Treatment of caliceal diverticular stones: Transdiverticular percutaneous nephrolithotomy with creation of a neoinfundibulum

PURPOSE: To evaluate transdiverticular percutaneous nephrolithotomy (TDPN) with creation of a neoinfundibulum in the treatment of caliceal diverticula r stones. PATIENTS AND METHODS: Between 1990 and 1998, 18 patients with symptomatic c alculi in caliceal diverticula underwent TDPN, Transdiverticular puncture i nto the renal collecting system with creation of a neoinfundibulum was used , eliminating the need for prolonged probing with a wire for the neck of th e diverticulum. Eight diverticula were upper polar, six were interpolar, an d four were in the lower pole. Stones were endoscopically treated with use of Lithoclast (Electromedical Systems, Lausanne, Switzerland), graspers, ul trasound, or a combination of these methods, RESULTS: Sixteen kidneys (89%) were rendered stone-free at discharge. Two k idneys (11%) were left with stone fragments of 5 mm or smaller. Hospital st ay ranged from 3 to 15 days (average, 7 days). Procedure time ranged from 4 5 to 169 minutes (average, 87 minutes). One patient developed a left renal- pleural fistula, which closed 1 week after chest tube drainage. No other co mplications were encountered for an overall complication rate of 6%. CONCLUSION: TDPN is a safe and effective method for treating caliceal diver ticular stones, with a complication rate comparable to other methods.