title: Treatment of symptomatic caliceal diverticula using a mini-percutaneous technique with greater than 3-year follow-up.
abstract: OBJECTIVE
  Caliceal diverticula can be treated with a variety of techniques. Traditional percutaneous techniques utilize nephrostomy-tract dilation to between 26F and 32F. Identification of a small diverticulum can be difficult after such dilation. The mini-percutaneous nephrolithotomy technique has been described for the treatment of nephrolithiasis. We report on two patients with caliceal diverticula treated using a mini-perc technique with long-term follow-up.
  
  
  METHODS
  Two symptomatic patients underwent treatment of posterior caliceal diverticula using a mini-perc technique. An interventional radiologist placed an 8F nephrostomy tube for access to the diverticulum. The following day, a 12F/14F ureteral access sheath was placed over a guidewire. Through the sheath, we identified the diverticulum and its neck with a 7F semirigid ureteroscope. The diverticular neck was balloon dilated to 18F, followed by fulguration with a 3F Bugbee electrode. A Double-J ureteral stent was placed antegrade from the diverticulum to the bladder, and an 8F nephrostomy tube provided external drainage.
  
  
  RESULTS
  The mean operative time was 138.5 minutes, and the mean estimated blood loss was 10 mL. Neither of the diverticula contained calculi. The mean length of stay was 2.5 days, and there were no complications. The hemoglobin and creatinine values showed no significant change. Both patients remained asymptomatic at a mean follow-up of 38 months.
  
  
  CONCLUSIONS
  Treatment of a caliceal diverticulum via a mini-perc technique is safe, effective technique with durable long-term results. It offers a less-invasive alternative to standard percutaneous treatment with larger access sheaths.
authors.affiliation: Department of Urology, Division of Laparoscopic Surgery and Endourology, Loyola University Medical Center, Maywood, Illinois 60163, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Kontak
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Wright
authors.forename: Thomas M T
authors.initials: TM
authors.lastname: Turk
mesh_terms: D000328:Adult; D004240:Diverticulum / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007670:Kidney Calices / Q000000981:diagnostic imaging / Q000601:surgery*; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome