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Management of calyceal diverticular calculi: a comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy

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Abstract

To compare the outcomes in patients who have been treated with flexible ureterorenoscopy (f-URS) and percutaneous nephrolithotomy (PNL) in managing stone-bearing caliceal diverticula. Between April 2007 and October 2013, we performed a retrospective analysis of 54 evaluable patients (28 women and 26 men) with symptomatic stone-bearing caliceal diverticula, who underwent PNL (n = 29) or F-URS (n = 25) in four referral hospitals in Turkey. The groups were compared with respect to demographics, stone location/size, success rate, stone-free status, symptom-free status, complication rates, and hospital stay. The average stone burden preoperatively was significantly larger in patients who were treated with PNL, with the average size for f-URS being 154 ± 77 mm2 and that for PNL being 211 ± 97 mm2 (p = 0.023). Symptom-free rates, success rates, stone-free rates and clinically insignificant residual fragments were similar between the groups (p = 0.880 vs. p = 0.537 vs. p = 0.539, and p = 0.877, respectively). There was no statistical difference between the groups for minor complications (p = 0.521) but no major complication (Clavien III–V) occured in the f-URS group; although there were three major complications (10.3 %) (Clavien III) in the PNL group (p < 0.001). Hospitalization time per patient was 1.04 ± 0.20 days in the f-URS group, while it was 3.86 ± 1.94 days in the PNL group (p < 0.001). Even though this study clearly shows that both techniques have high overall success and symptom-free rates with similar complication rates for stone-bearing calyceal diverticulum, major complication rates may suggest consideration of the invasiveness of PNL. The f-URS procedure is advantageous with respect to a shorter hospital stay and absence of major complications. Therefore, it should be emphasized that the location of the stone and diverticula is an important factor for the selection of the procedure.

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Abbreviations

SWL:

Extracorporeal shockwave lithotripsy

f-URS:

Flexible ureterorenoscopy

PNL:

Percutaneous nephrolithotomy

IVU:

Intravenous urogram

CT:

Computerized tomography

CIRFs:

Clinically insignificant residual fragments

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No competing financial interests exist.

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Authors and Affiliations

  1. Department of Urology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ministry of Health, Ankara, Turkey

    Okan Bas, Serhat Ozgun, Fatih Hizli & Halil Basar

  2. Department of Urology, Kecioren Education and Research Hospital, Ministry of Health, Ankara, Turkey

    Ekrem Ozyuvali, Cagri Senocak & Omer Faruk Bozkurt

  3. Department of Urology, Dr Sami Ulus Maternity, Children’s Health and Diseases Training and Research Hospital, Ministry of Health, Ankara, Turkey

    Yasin Aydogmus

  4. Department of Urology, Numune Education and Research Hospital, Ministry of Health, Adana, Turkey

    Nevzat Can Sener

  5. Department of Urology, Bitlis Tatvan State Hospital, Ministry of Health, Bitlis, Turkey

    Onur Dede

  6. Department of Urology, Diskapi Yildirim Beyazid Training and Research Hospital, Ministry of Health, Ankara, Turkey

    Abdurrahim Imamoglu

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  1. Okan Bas
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  2. Ekrem Ozyuvali
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Correspondence to Okan Bas.

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Bas, O., Ozyuvali, E., Aydogmus, Y. et al. Management of calyceal diverticular calculi: a comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy. Urolithiasis 43, 155–161 (2015). https://doi.org/10.1007/s00240-014-0725-5

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  • DOI: https://doi.org/10.1007/s00240-014-0725-5

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