Management of symptomatic caliceal diverticular calculi:Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy

• Published in: Chronic diseases and translational medicine Vol. 2; no. 4; pp. 250 - 256
• Main Authors: Ding, Xiang, Xu, Song-Tao, Huang, Yu-Hua, Wei, Xue-Dong, Zhang, Jiang-Lei, Wang, Liang-Liang, Pu, Jin-Xian, Hou, Jian-Quan, Yan, Chun-Yin, Cui, Feng-Mei
• Format: Journal Article
• Language: Chinese; English
• Published: China Elsevier B.V 01.12.2016; Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China%Department of Clinical Medicine, Luohe Medical College, Luohe, Henan 462002, China%Department of Toxicology, School of Radiation Medicine and Public Health, Soochow University, Suzhou, Jiangsu 215123, China; KeAi Publishing; Wiley
• Subjects: Caliceal diverticular calculi; Flexible ureterorenoscopy; Minimally invasive percutaneous nephrolithotomy; Original; Caliceal diverticular calculi; Flexible ureterorenoscopy; Minimally invasive percutaneous nephrolithotomy
• ISSN: 2095-882X; 2589-0514; 2589-0514
• DOI: 10.1016/j.cdtm.2016.11.016

Objective: To retrospectively evaluate appropriate treatment for patients with symptomatic caliceal diverticular calculi, by comparing the therapeutic outcomes for those undergoing minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureterorenoscopy (F-URS). Methods: From March 2009 to May 2014, 36 consecutive patients with caliceal diverticular calculi were divided into 2 groups:21 patients underwent MPCNL, and 15 were treated by F-URS. All procedures were performed by one surgical group, which ensured relatively constant parameters. Patient characteristics, operative time, hospital stay after surgery, stone-free rate, symptomatic improvement rate, complications, diverticular obliteration, and stone composition were analyzed retrospectively in the 2 groups. Results: Patient preoperative variables were comparable between the two groups, with no significant difference (P>0.05). Mean operative time was 136.9 ± 22.8 min in the MPCNL group and 117.3 ± 24.3 min in the F-URS group (P ? 0.019). Hospital stay was significantly longer in the MPCNL group than in the F-URS group (9.4 ± 3.1 vs. 6.9 ± 2.1 days, P ? 0.010). The stone-free rates after MPCNL and F-URS were 90.5%(19/21) and 60.0%(9/15), respectively (P ? 0.046). Additionally, 71.4%(15/21) of patients in the MPCNL group and 46.7%(7/15) of patients in the F-URS group had symptomatic improvement at the 6-month follow-up (P ? 0.175);the rates of complications in the 2 groups were 19.0%(4/21) and 13.3%(2/15), respectively (P ? 0.650). Complete diverticular obliteration was achieved in 16 (76.2%) cases in the MPCNL group and 5 (33.3%) cases in the F-URS group (P ? 0.017). The distributions of calcium oxalate and hydroxyapatite in the stones were 66.7% (14/21) and 33.3% (7/21), respectively, in the MPCNL group;however, the distributions in the F-URS group were 46.7%(7/15) and 53.3%(8/15), respec-tively (P ? 0.310). Conclusion: MPCNL is an effective method for the treatment of caliceal diverticular calculi. However, F-URS is an alternative technique in selected patients with a patent infundibulum, despite lower stone-free rates than with MPCNL. Fulguration of the diverticular lining with a high-power holmium laser and permitting the cavity to collapse are useful to increase the chance of diverticular obliteration.