Treatment of caliceal diverticular stones: transdiverticular percutaneous nephrolithotomy with creation of a neoinfundibulum.
OBJECTIVE
To evaluate transdiverticular percutaneous nephrolithotomy (TDPN) with creation of a neoinfundibulum in the treatment of caliceal diverticular stones.


METHODS
Between 1990 and 1998, 18 patients with symptomatic calculi in caliceal diverticula underwent TDPN. Transdiverticular puncture into the renal collecting system with creation of a neoinfundibulum was used, eliminating the need for prolonged probing with a wire for the neck of the diverticulum. Eight diverticula were upper polar, six were interpolar, and four were in the lower pole. Stones were endoscopically treated with use of Lithoclast (Electromedical Systems, Lausanne, Switzerland), graspers, ultrasound, or a combination of these methods.


RESULTS
Sixteen kidneys (89%) were rendered stone-free at discharge. Two kidneys (11%) were left with stone fragments of 5 mm or smaller. Hospital stay ranged from 3 to 15 days (average, 7 days). Procedure time ranged from 45 to 169 minutes (average, 87 minutes). One patient developed a left renal-pleural fistula, which closed 1 week after chest tube drainage. No other complications were encountered for an overall complication rate of 6%.


CONCLUSIONS
TDPN is a safe and effective method for treating caliceal diverticular stones, with a complication rate comparable to other methods.
Department of Diagnostic Radiology, St. Joseph's Health Centre, London, Ontario, Canada.
S
S
Al-Basam
J D
JD
Bennett
Z A
ZA
Layton
J D
JD
Denstedt
H
H
Razvi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004240:Diverticulum / Q000628:therapy*; D004724:Endoscopy; D005260:Female; D005402:Fistula / Q000209:etiology; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D007670:Kidney Calices / Q000473:pathology*; D007674:Kidney Diseases / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D010995:Pleural Diseases / Q000209:etiology; D011677:Punctures; D012449:Safety; D013997:Time Factors; D014548:Urinary Fistula / Q000209:etiology