Long term results of percutaneous treatment of caliceal diverticular calculi.

Purpose: We reviewed the long term outcome of percutaneous caliceal diverticular stone extraction. The objective was to define factors of treatment failure and recurrence.

Material And Methods: Percutaneous caliceal diverticular stone extraction was performed in 24 women and 7 men (age range 21-69 years old). Diverticula were located throughout the kidney including the upper, middle and lower calices. In all cases stones were removed using a direct approach and diverticular neck was incised or dilated. Fulguration of the diverticular walls was performed in 6 cases. Trans-diverticular drainage was maintained from 3 to 5 days (mean 3.4 days) until a nephrostomogram demonstrated no extravasation. Patients were evaluated at 3 months and yearly thereafter. Success criteria were: no symptoms, no stone recurrence, no diverticulum left as assessed by IVP. Evaluation at 1 year minimum is presented.

Results: The average operative time and hospital stay were 103 min (range 90-130) and 3 days (range 4-9 days), respectively. No major complications and no mortality were observed. At 1 year stone free rate was 84% and diverticulum obliteration was obtained in 68% of patients. Overall 88% of patients were asymptomatic at average followup 24.6 months (range from 18 to 96 months). In all cases morphological or symptomatic failures were related to the quality of immediate result at surgery which relates to the location of the diverticulum.

Conclusion: The percutaneous management of diverticular caliceal stones is a well standardized technique, however, surgical alternatives must be discussed any time the percutaneous approach seems difficult because high failure rates are expected in these cases.