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Patodia M et al, 2017: Management of renal caliceal diverticular stones: A decade of experience.

Patodia M, Sinha RJ, Singh S, Singh V.
Department of Urology, Narayana Multispeciality Hospital, Jaipur, Rajasthan, India.
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Abstract

OBJECTIVE: The objective of this study is to evaluate our methods for management of renal caliceal diverticular stones (CDS).
MATERIALS AND METHODS: We conducted a retrospective study from January 2005 to July 2015 and included patients who were treated for renal CDS. Patients were evaluated for treatment modality, puncture site (in case percutaneous nephrolithotomy [PCNL] attempted), operative time, stone clearance rate, and complications. During PCNL, if the infundibulum was found to connect the diverticulum to the calyx, then a double J stent was placed. No attempt was made to dilate the diverticular neck or to create a neoinfundibulum.
RESULTS: Twenty-four patients were treated for CDS during the study period. Two patients underwent shockwave lithotripsy, and 22 were managed by PCNL. Mean stone size was 16.37 mm (range: 6-35 mm) and mean diverticulum size was 20.62 mm (range: 12-37 mm). No fulguration was done in initial 17 patients, while fulguration by Holmium Laser was performed in the last five cases treated with PCNL. Mean operative time was 70.31 min (range: 47-90 min). Mean follow-up was 34 months, diverticulum resolved in 14 patients and reduced in size in 7 patients.
CONCLUSION: Caliceal diverticular calculi can be treated most efficiently by PCNL. Stone-guided puncture and no attempt to dilate or create neoinfundibulum reduces operative time and morbidity while yielding high stone-free rate.

Urol Ann. 2017 Apr-Jun;9(2):145-149. doi: 10.4103/UA.UA_95_16.

 

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Comments 1

Peter Alken on Monday, 13 November 2017 08:37

Only three patients were treated with ESWL: “Three patients underwent ESWL as per their personal preference. Two patients had complete clearance of stone in ESWL group after one setting. In one patient, stone was not fragmented even after three settings of ESWL. This patient was subjected to PCNL later on. During follow‑up, the two patients who had received ESWL had stone recurrence and were treated again by ESWL. Complete clearance was achieved after one setting of ESWL.” Unfortunately the authors do not report how two of the ESWL-patients knew that ESWL would be successful :-).

Only three patients were treated with ESWL: “Three patients underwent ESWL as per their personal preference. Two patients had complete clearance of stone in ESWL group after one setting. In one patient, stone was not fragmented even after three settings of ESWL. This patient was subjected to PCNL later on. During follow‑up, the two patients who had received ESWL had stone recurrence and were treated again by ESWL. Complete clearance was achieved after one setting of ESWL.” Unfortunately the authors do not report how two of the ESWL-patients knew that ESWL would be successful :-).
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