CALYCEAL diverticulum is a cystic intrarenal cavity lined by nonsecretory transitional epithelium that communicates with the collecting system via a narrow isthmus or infundibulum. It is arare anatomic anomaly with an...CALYCEAL diverticulum is a cystic intrarenal cavity lined by nonsecretory transitional epithelium that communicates with the collecting system via a narrow isthmus or infundibulum. It is arare anatomic anomaly with an incidence of 0.2% to 0.6% in the patients undergoing renal imaging.1 Single imaging modality usually cannot differentiate calyceal diverticulum from other cystic renal diseases.2 Here, we report a 60-year-old male who was reliably diagnosed with calyceal diverticulum by retrograde urography combined with non-enhanced computed tomography （CT） and magnetic resonance urography （MRU）.展开更多
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modal...The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.展开更多
Background： Percutaneous nephrolithotomy （PCNL） is the most widely recommended treatment lbr calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible consid...Background： Percutaneous nephrolithotomy （PCNL） is the most widely recommended treatment lbr calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy （FURS） is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy （UFURS） identifying diverticulum and the managenlent of calyceal diverticular calculi. Methods： A retrospective analysis was conducted on 24 patients who had calyceal diverticnlar calculi. In all 12 patients in tile UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the divenicular walls. Results： Puncture ofcalyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed lever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time （UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min）, stone-free rate （UFURS vs. PCNL, 9/12 vs. 10/12）, and rate of successful lithotripsy （UFURS vs. PCNL, 10/12 vs. 11/12） between the two groups （all P 〉 0.05）. Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group （2.7 ±1.2 vs. 6.2 ±1.5. P 〈 0.05）. Hospital stay in the UFURS group was significantly shorter than that in the PCNL group （3.4 ± 0.8 vs. 5.4 ± 1.0 days, P 〈 0.05）. All patients were symptom-free following surgery （UFURS vs. PCNL, 10/10 vs. 12/12）. Conclusion： Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.展开更多
文摘CALYCEAL diverticulum is a cystic intrarenal cavity lined by nonsecretory transitional epithelium that communicates with the collecting system via a narrow isthmus or infundibulum. It is arare anatomic anomaly with an incidence of 0.2% to 0.6% in the patients undergoing renal imaging.1 Single imaging modality usually cannot differentiate calyceal diverticulum from other cystic renal diseases.2 Here, we report a 60-year-old male who was reliably diagnosed with calyceal diverticulum by retrograde urography combined with non-enhanced computed tomography （CT） and magnetic resonance urography （MRU）.
文摘The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.
文摘Background： Percutaneous nephrolithotomy （PCNL） is the most widely recommended treatment lbr calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy （FURS） is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy （UFURS） identifying diverticulum and the managenlent of calyceal diverticular calculi. Methods： A retrospective analysis was conducted on 24 patients who had calyceal diverticnlar calculi. In all 12 patients in tile UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the divenicular walls. Results： Puncture ofcalyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed lever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time （UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min）, stone-free rate （UFURS vs. PCNL, 9/12 vs. 10/12）, and rate of successful lithotripsy （UFURS vs. PCNL, 10/12 vs. 11/12） between the two groups （all P 〉 0.05）. Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group （2.7 ±1.2 vs. 6.2 ±1.5. P 〈 0.05）. Hospital stay in the UFURS group was significantly shorter than that in the PCNL group （3.4 ± 0.8 vs. 5.4 ± 1.0 days, P 〈 0.05）. All patients were symptom-free following surgery （UFURS vs. PCNL, 10/10 vs. 12/12）. Conclusion： Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.
