ABSTRACT
Objective:To investigate the efficacy and safety of retrograde intrarenal surgery(RIRS) with holmium laser lithotripsy in the management of calyceal diverticular calculi.Methods:A retrospective analysis was performed on 56 patients with calyceal diverticular calculi admitted to Huashan Hospital of Fudan University from January 2017 to May 2020. The 56 cases included 25 males and 31 females. The average age was 37.4 (ranging 22-67) years. Calyceal diverticular stones were located in the upper pole of the kidney in 32 cases, middle pole in 16 case and lower pole in 8 cases, with 32 cases on the left side and 24 cases on the right side. Multiple stones occurred in 46 cases, and single stone in 10 cases. The mean diameter of stones was 11.5 (ranging 3.0-17.5)mm. All 56 patients had different degrees of lumbar pain and/or hematuria preoperatively. Among them, 17 patients received extracorporeal shock wave lithotripsy (ESWL) with failure. Moreover, 9 cases suffered with urinary infection. All 56 patients with calyceal diverticular calculi underwent retrograde flexible ureterorenoscopic Ho: YAG laser lithotripsy under general anesthesia. The flexible ureterorenoscope was advanced into the kidney through the ureteral access sheath, looking for the cervical orifice of calyceal diverticulum. After finding renal diverticulum, holmium laser was used to incise and expand the neck or weak part of the diverticulum. The diverticular calculi were fragmented into particles less than 3 mm. Larger fragments were removed through a nitinol stone basket one by one. A F6 D-J stent was indwelled. The intraoperative conditions, postoperative complication rate and stone free rate were statistically analyzed.Results:The calyceal diverticular calculi in all 56 patients were discovered, and the diverticulum orifice were identified in 48 patients(85.7%). 53 of them underwent calyceal diverticular calculi fragmentation successfully. Lithotripsy failed in 3 cases, as the calculi were incarcerated in the lower pole calyceal diverticulum with a long narrow neck and the limitation of flexure at the end of the flexible ureteroscope. Two of them underwent percutaneous nephrolithotomy instead due to the calculi located in the posterior calyx. In another one case, ESWL was performed as the calculi located in the anterior calyx. Of the 17 cases received unsuccessful ESWL, RIRS was successful in 16 cases (94.1%). The mean operative time was 68.1(ranging 37-105)min, and mean hospitalization was 1.8 (ranging 1-3)d. The complication rate was 15.1%(8/53). All of these complications were mild (Clavien Ⅰ-Ⅱ). No serious complications such as perforation of the renal pelvis and ureter or major bleeding were occurred. After mean postoperative follow-up of 6.3(ranging 3-12) months, the stone-free rate was 83.0% (44/53) after the first procedure. 7 cases with residual stones ≥4mm received a second procedure. Among them, 6 cases received flexible ureterorenoscopy and the other one received ESWL and external physical vibration lithecbole therapy. The stone-free rate and symptom remission rate was 92.5% (49/53) and 96.2% (51/53) respectively after the second procedure, and no recurrence of calyceal diverticular calculi was observed during the stage of fllow-up.Conclusions:RIRS with holmium laser lithotripsy in the treatment of calyceal diverticular calculi, using the body's natural cavities, is a minimally invasive, safe and efficient strategy with slight complications. RIRS with holmium laser lithotripsy is an optional treatment for calyceal diverticular calculi.
ABSTRACT
Objective To evaluate the efficacy of ultrasound guided diverticular puncture combined with flexible ureteroscope to treat calyceal diverticulum calculi, which is difficult in finding the diverticular orifice during ureteroscopic surgery.Methods From November 2012 to July 2015, Twenty-four cases suffered caliceal diverticulum calculi were treated with PCNL or flexible ureterorenoscopic methods.Twelve cases were treated with PCNL in Group PCNL, and 12 cases in Group FURS were all not found orifice or wall under flexible ureteroscope. For Group FURS, ultrasound guided nephrostomy needle puncturing into diverticular calvity were performed, saline-diluted methylthioninium chloride was injected through needle sheaths.The diverticular opening could be recognized in six cases.Guidewires were inserted through needle sheaths for identifying the wall of diverticular cavity in another six cases that could not find the orifice.The stenotic infundibulum or diverticular wall was incised with 200 micron holmium laser fiber for fragment or extraction of diverticular calculi.Results The time of operation, stone free and fragment success cases in Group FURS and PCNL were ( 91.8 ±24.2 ) min vs.( 86.3 ±18.7 ) min, 9 cases vs.10 cases, and 10 cases vs.11 cases, respectively ( P all >0.05 ) .Residual calculi with clinical significance in Group FURS and PCNL disappeared after the second FURS surgery.The VAS score in Group FURS was marked lower than that in Group PCNL [ ( 3.1 ±1.2 ) vs.( 5.3 ±0.9 ) , P﹤0.05 ] .There was no significant difference complication rate between two groups ( 2 cases vs.3 cases, P>0.05 ) .Hospital stay in Group FURS was dramaticly shorter than Group PCNL(3.4 ±0.8) d vs.(5.4 ±1.0) d,P﹤0.05).Diverticula disappeared in 6 cases and became smaller in 6 cases in Group FURS, disappeared in 10 cases and became smaller in 2 cases in Group PCNL.Conclusion Flexible ureteroscope combining with the ultrasound guided puncture of diverticular calvity for management of caliceal diverticula maybe a safe and effective option.
ABSTRACT
Calyceal diverticula are eventrations of the upper collecting system, lying within the renal parenchyma, communicating with the main collecting system via a narrow channel and lining by transitional tell epithelium. Most are asyptomatic and rarely require any form of treatment but complicated one needs surgical correction. We experienced one case of calyceal diverticulum associated with stone in 47 year old man. This calyceal diverticulum was removed by partial nephrectomy.
Subject(s)
Humans , Middle Aged , Deception , Diverticulum , Epithelium , NephrectomyABSTRACT
Authors present here in a calyceal diverticulum complicated by chronic pyelonephritis, which was diagnosed on urinalysis, IVP, RGP and symptoms. Partial nephrectomy was done and confirmation was made by specimen gross findings and biopsy. The microscopic findings are as follows: The lining epithelium of the inner surface of the cystically dilated calyx is made up of transitional epithelial cells. The epithelium in the areas is eroded. The subepithelial interstitial tissue is fibrotic and infilterated with large numbers of chronic inflammatory cells, which also invade the underlying renal parenchyma.
Subject(s)
Biopsy , Cytochrome P-450 CYP1A1 , Diverticulum , Epithelial Cells , Epithelium , Nephrectomy , Pyelonephritis , UrinalysisABSTRACT
We wish to report 8 cages of calyceal diverticula which were diagnosed tentatively among cases of I.V.P. during the period from January 1965 to December 1971 at St. Mary's Hospital. There were 5 male and 3 female patients. The right kidney was involved in all patients The upper calyx was involved in 6 patients and the middle calyx in 2 patients. Lumbar or abdominal pain was present in 5 patients. 1 of the 8 patients had undergone appendectomy with removal of a norma1 appendix prior to diagnosis.Pyuria were found in 3 patients and one patient had single stone within the diverticulum.
Subject(s)
Female , Humans , Male , Abdominal Pain , Appendectomy , Appendix , Diverticulum , KidneyABSTRACT
Authors present herein a calyceal diverticulum complicated by chronic pyelonephritis, which was diagnosed tentatively on I.V.P. and confirmed by operation, in a woman of 22 yeas old who had been admitted to our clinic because of urinary infection. And also, literatures on this condition have been reviewed briefly.