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

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...

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Autores principales:	Xiang Ding, Song-Tao Xu, Yu-Hua Huang, Xue-Dong Wei, Jiang-Lei Zhang, Liang-Liang Wang, Jin-Xian Pu, Jian-Quan Hou, Chun-Yin Yan, Feng-Mei Cui
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2016
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d3b4afec134c43d9a1fec7f261b462c7
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spelling	oai:doaj.org-article:d3b4afec134c43d9a1fec7f261b462c72021-12-02T12:54:38ZManagement of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy2095-882X10.1016/j.cdtm.2016.11.016https://doaj.org/article/d3b4afec134c43d9a1fec7f261b462c72016-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095882X16301323https://doaj.org/toc/2095-882XObjective: 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), respectively (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. Keywords: Caliceal diverticular calculi, Minimally invasive percutaneous nephrolithotomy, Flexible ureterorenoscopyXiang DingSong-Tao XuYu-Hua HuangXue-Dong WeiJiang-Lei ZhangLiang-Liang WangJin-Xian PuJian-Quan HouChun-Yin YanFeng-Mei CuiKeAi Communications Co., Ltd.articleMedicine (General)R5-920ENChronic Diseases and Translational Medicine, Vol 2, Iss 4, Pp 250-256 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Xiang Ding Song-Tao Xu Yu-Hua Huang Xue-Dong Wei Jiang-Lei Zhang Liang-Liang Wang Jin-Xian Pu Jian-Quan Hou Chun-Yin Yan Feng-Mei Cui Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
description	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), respectively (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. Keywords: Caliceal diverticular calculi, Minimally invasive percutaneous nephrolithotomy, Flexible ureterorenoscopy
format	article
author	Xiang Ding Song-Tao Xu Yu-Hua Huang Xue-Dong Wei Jiang-Lei Zhang Liang-Liang Wang Jin-Xian Pu Jian-Quan Hou Chun-Yin Yan Feng-Mei Cui
author_facet	Xiang Ding Song-Tao Xu Yu-Hua Huang Xue-Dong Wei Jiang-Lei Zhang Liang-Liang Wang Jin-Xian Pu Jian-Quan Hou Chun-Yin Yan Feng-Mei Cui
author_sort	Xiang Ding
title	Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
title_short	Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
title_full	Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
title_fullStr	Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
title_full_unstemmed	Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
title_sort	management of symptomatic caliceal diverticular calculi: minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy
publisher	KeAi Communications Co., Ltd.
publishDate	2016
url	https://doaj.org/article/d3b4afec134c43d9a1fec7f261b462c7
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Management of symptomatic caliceal diverticular calculi: Minimally invasive percutaneous nephrolithotomy versus flexible ureterorenoscopy

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