Endocalicotomy in tuberculous renal caliceal stricture.
The stricture of the calix, renal pelvis, or ureter secondary to renal tuberculosis has been managed by nephrectomy, partial nephrectomy, ureteroileoneocystoplasty, or even pancaliceal-ileoneocystoplasty. To salvage the renal parenchyma, percutaneous endocalicotomy with or without endopyelotomy was performed in 10 patients. The main sites of stricture were an upper calix in six cases and a lower calix in four. A cold knife was used to incise the stricture, and a stenting two-section 14F endopyelotomy catheter was retained for 6 to 8 weeks. Postoperative intravenous urography revealed marked shrinkage of the dilated calix in seven cases, moderate shrinkage in one, and no change in two (success rate 80%). One of the patients in whom the procedure failed underwent partial nephrectomy, and the other is being followed. The only significant complication was one case of pyelonephritis. Endocalicotomy is a safe, less invasive, successful (in cases that a guidewire could pass), and parenchyma-saving procedure. Retrograde pyelography is mandatory just before the surgery because stricture can worsen during antituberculosis chemotherapy.
Hwang
T K
TK
Department of Urology, Catholic University Medical College, Seoul, Korea.
Park
Y H
YH
D000293:Adolescent; D000328:Adult; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007674:Kidney Diseases / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014398:Tuberculosis, Renal / Q000150:complications*; D014567:Urography; D014570:Urologic Diseases / Q000209:etiology* / Q000601:surgery*