Percutaneous nephrolithotomy of caliceal diverticular calculi: a single center experience.

Background and Purpose: Caliceal diverticula are rare renal anomalies present in approximately 0.6% of the population. They are associated with calculi in 50% of cases. Therapeutic options include several minimally invasive techniques. We report a retrospective review of outcomes and complications from our series of patients who were treated with a percutaneous approach.
Patients and Methods: A database of outcomes related to percutaneous nephrolithotomy (PCNL) has been maintained at our institution since 1992. Data on all patients with caliceal diverticular stones who underwent PCNL during a 17-year period from 1992 to 2009 were reviewed retrospectively. Our preferred approach to PCNL in these patients is to puncture directly into the diverticulum and to try to advance a guidewire through the infundibular neck. In cases where the caliceal neck could not be intubated, we performed a transdiverticular approach with creation of a neoinfundibulum as a salvage procedure. We evaluated the two techniques with regard to stone-free rates and early postoperative complications.
Results: Seventy-six procedures were performed. The mean age was 43 years (range 17-72 y). The mean stone area was 583 mm(2). The surgical approach was direct puncture in 47, transdiverticular in 20, retrograde in 8, and unknown in 1 patient. Eight patients underwent lining fulguration. The average duration of surgery was 75 minutes (23-169 min) with an average hospital stay of 4.7 days. There were a total of 23 complications, of which 11 necessitated additional intervention. The overall stone-free rates were 77% and 89% for direct puncture and transdiverticular approaches, respectively.
Conclusions: The percutaneous management of caliceal diverticular calculi is highly effective and can be accomplished with low morbidity.