Pre-percutaneous nephrolithotomy opacification for caliceal diverticular calculi

Area of Science:

• Nephrology
• Urology
• Radiology

Background:

• Caliceal diverticula are common renal collecting system anomalies.
• Calculi within caliceal diverticula occur in up to 50% of patients.
• Spontaneous passage of these calculi is rare, necessitating intervention.

Observation:

• Traditional diagnostic methods like retrograde or intravenous urography may fail to opacify the diverticulum.
• This is particularly true for nonradiopaque stones or poorly opacifying diverticula.
• Direct contrast instillation into the diverticular cavity under CT or ultrasound guidance was employed.

Findings:

• This technique successfully visualized the calculi and diverticular anatomy.
• Percutaneous stone removal techniques, guided by this direct instillation, yielded good results.
• Three cases demonstrated the efficacy of this approach.

Implications:

• Direct contrast instillation is a valuable adjunct for diagnosing and planning treatment for calculi in challenging caliceal diverticula.
• This method enhances the success of stone removal procedures, particularly percutaneous techniques.
• It expands treatment options for patients with difficult-to-manage renal calculi.