Related Experiment Videos
Endoscopic management of completely excluded calices: a single institution experience
Adam C Mues1, Jaime Landman, Mantu Gupta
1Department of Urology, Columbia University Medical Center, New York, New York 10032, USA. adammues@gmail.com
Insights
Endoscopic management effectively treats excluded calices, often caused by prior renal surgery. This approach, involving neoinfundibulum creation, successfully restores collecting system continuity and resolves symptoms without complications.
Area of Science:
- Urology
- Endourology
Background:
- Excluded calices are renal collecting system segments isolated due to infection, malignancy, or post-surgical inflammation.
- These conditions often arise secondary to endoscopic renal surgery or other urological procedures.
Purpose of the Study:
- To report the experience with endoscopic management of excluded calices.
- To evaluate the efficacy and safety of endoscopic techniques for restoring collecting system continuity.
Main Methods:
- Retrospective review of patients diagnosed with excluded calices.
- Treatment involved endoscopic techniques, including percutaneous approaches, laser incision, balloon dilatation, and stent placement, all requiring neoinfundibulum formation.
- Patients were assessed for symptomatic and radiographic resolution.
Main Results:
- Eight patients with excluded calices were identified, most with a history of urolithiasis and prior endoscopic renal surgery.
- Six patients were treated successfully with percutaneous endoscopic methods.
- One patient required re-treatment, and no complications were reported.
Conclusions:
- Excluded calices frequently result from inflammation following renal surgery.
- Endoscopic management aims to relieve obstruction, manage stones, and reconnect the isolated calix to the collecting system.
- Successful endoscopic treatment involves neoinfundibulum creation and temporary ureteral stent placement.
Background And Purpose:
Excluded calices refer to a single calix or multiple calices that are completely isolated from the collecting system. The etiology is a result of infection, malignancy, or inflammation that is secondary to endoscopic renal surgery. We report our experience with the endoscopic management of excluded calices.
Patients And Methods:
We retrospectively reviewed the data for our patients with a diagnosis of excluded calices. Patients were treated with various endoscopic techniques, all necessitating the formation of a neoinfundibulum. Patients were evaluated for symptomatic and radiographic evidence of resolution.
Results:
Eight patients were found to have excluded calices. Seven patients had a history of urolithiasis and previous endoscopic renal surgery. One patient had undergone a laparoscopic partial nephrectomy with a postoperative urinary fistula. Six of eight patients were treated with a percutaneous approach followed by laser incision, balloon dilatation, or nephroureteral stent placement. Two objective failures occurred. One patient received re-treatment and has not demonstrated persistence or recurrence since the second procedure. No complications occurred as a result of endoscopic management.
Conclusion:
Excluded calices commonly result from inflammation from previous renal surgery. Goals of management include relief of obstruction, management of stones, and regaining continuity with the remaining collecting system. Successful treatment with endoscopic management involves creation of a neoinfundibulum and placement of a temporary ureteral stent.