Calyceal diverticulum (CD) is the outpouching of a calyx into the renal parenchyma, connected by an infundibulum. Often associated with recurrent stones, common surgical options include percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS).
We aim to present the real-world practises and outcomes comparing both approaches and the technical choices made.
Retrospective data including 313 patients from 11 countries were evaluated. One hundred and twenty-seven underwent mini-PCNL and one hundred and eighty-six underwent RIRS. Patient demographics, perioperative parameters, and outcomes were analysed using either T test or Mann-Whitney U test. Categorical data between groups were analysed using the Chi-squared test. Propensity score matching (PSM) was performed matching for baseline characteristics. Subgroup analyses for anomalous/malrotated kidneys and difficult diverticulum access were performed.
After PSM, 123 patients in each arm were included, with similar outcomes for stone-free rate (SFR) and complications (p < 0.001). Hospitalisation was significantly longer in PCNL. Re-intervention rate for residual fragments (any fragment > 4 mm) was similar. RIRS was the preferred re-intervention for both groups. Intraoperative bleeding was significantly higher in PCNL (p < 0.032) but none required transfusion. Two patients with malrotated anatomy in RIRS group required transfusion. Lower pole presented most difficult access for both groups, and SFR was significantly higher in difficult CD accessed by RIRS (p < 0.031). Laser infundibulotomy was preferred for improving diverticular access in both. Fulguration post-intervention was not practised.
The crux lies in identification of the opening and safe access. Urologists may consider a step-up personalised approach with a view of endoscopic combined approach where required.
World journal of urology. 2023 Oct 21 [Epub ahead of print]
Vineet Gauhar, Olivier Traxer, Shauna Jia Qian Woo, Khi Yung Fong, Deepak Ragoori, Amish Wani, Boyke Soebhali, Abhay Mahajan, Maheshwari Pankaj, Nariman Gadzhiev, Yiloren Tanidir, İlker Gokce Mehmet, Cemil Aydin, Yakup Bostanci, Saeed Bin Hamri, Fahad R Barayan, Mriganka Mani Sinha, Takaaki Inoue, Jeremy Yuen-Chun Teoh, Daniele Castellani, Bhaskar K Somani, Ee Jean Lim
Department of Urology, Ng Teng Fong Hospital, NUHS, Singapore, Singapore., Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France., Department of Urology, Singapore General Hospital, Singapore Health Services, Singapore, Singapore., Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Department of Urology, Asian Institute of Nephrourology, Hyderabad, India., Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia., Department of Urology, Sai Urology Hospital, Aurangabad, Maharashtra, India., Department of Urology, Fortis Hospital Mulund, Mumbai, India., Department of Urology, Saint-Petersburg State Medical University, Saint-Petersburg, Russia., Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Department of Urology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey., Department of Urology, Ondokuz Mayis University, Samsun, Turkey., Department of Urology, Advanced Laser Endourology at King Abdulaziz National Guard Medical City Saudi Arabia, Jeddah, Saudi Arabia., Division of Urology, Department of Surgery, Ministry of National Guard-Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Department of Urology, University Hospital NHS Trust, Southampton, UK., Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan., Department of Surgery, Faculty of Medicine, S. H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy., Department of Urology, Singapore General Hospital, Singapore Health Services, Singapore, Singapore. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37864647