Koopman SG et al, 2013: Management of stones associated with intrarenal stenosis: infundibular stenosis and caliceal diverticulum
Koopman SG, Fuchs G
Department of Urology, Cedars-Sinai , Los Angeles, California
PURPOSE: To review our experience with retrograde intrarenal surgery (RIRS) for management of conditions associated with intrarenal stricture and present a treatment algorithm based on the series.
PATIENTS AND METHODS: RIRS was offered to all patients with symptomatic intrarenal stenosis regardless of location if stone burden was 2 cm or less. With a combined endourology and lithotripsy table, patients with stones between 2 and 3 cm were also offered RIRS using a combined approach of RIRS and shockwave lithotripsy (SWL). A total of 108 patients with symptomatic stones and caliceal diverticulum or infundibular stenosis were included in the data analysis. A standard technique was used in all cases. Failures or patients not suitable for RIRS were treated with either percutaneous nephrolithotomy (PCNL) or laparoscopic surgery.
RESULTS: Successful identification and dilation/incision of the stenotic opening was accomplished in 94% of cases. Seventy-five percent of stones were managed with basketing and/or holmium laser ablation. In these patients, 90% were stone free (
CONCLUSIONS: With the appropriate equipment, RIRS provides a valid treatment option for patients with intrarenal strictures. While upper pole and midrenal lesions are ideal, lower pole segments may be approached as well. A treatment algorithm based on the results provides a simplified approach for the minimally invasive management of intrarenal stenosis.
J Endourol. 2013 Dec;27(12):1546-50. doi: 10.1089/end.2013.0186. Epub 2013 Nov 19.
PMID:24251427 [PubMed - in process]
The manuscript mainly deals with RIRS. There are no details given on the technique of combined SWL+RIRS used in 20% of the cases.