Kim SC et al. (2005) Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach. J Urol 173: 1194–1198

Current minimally invasive treatments for radiopaque caliceal diverticular calculi include shock wave lithotripsy, ureteroscopy, laparoscopy and percutaneous nephrolithotomy (PNL). Kim et al. have recently reviewed the outcomes for patients undergoing a novel, single-stage PNL technique that eliminates ureteral catheterization and entry into the renal collecting system.

Twenty-one patients with caliceal diverticular calculi took part in the study from February 2001 to September 2003 and were treated with single-stage PNL. Results showed that the mean operative time was reduced to 58.5 min. A stone-free rate of 85.7% was achieved—confirmed by non-contrast computerized tomography—and 14 out of 16 patients with follow-up excretory urography at 3 months had complete diverticular resolution. No transfusions were necessary and no pulmonary complications occurred as all punctures were performed infracostally. All patients, with the exception of one, were discharged home tubeless on postoperative day 1.

The authors conclude that standard PNL is the most effective approach for the treatment of symptomatic radiopaque caliceal diverticular stones; however, using a single-stage modified PNL technique significantly reduced operative times, while still achieving diverticular obliteration and a high stone-free rate. The authors highlight that single-stage PNL can be used for all radiopaque diverticular calculi regardless of diverticular location in the kidney.