Endocalicotomy in tuberculous renal caliceal stricture

Area of Science:

• Urology
• Nephrology
• Infectious Diseases

Background:

• Renal tuberculosis can cause strictures in the calix, renal pelvis, or ureter.
• Traditional management includes nephrectomy or complex reconstructive surgeries.
• There is a need for parenchyma-sparing interventions.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous endocalicotomy for managing renal tuberculosis-induced strictures.
• To assess the potential for renal parenchyma salvage.

Main Methods:

• Percutaneous endocalicotomy with or without endopyelotomy was performed in 10 patients.
• Strictures were incised using a cold knife.
• A 14F endopyelotomy catheter was used for stenting over 6-8 weeks.
• Retrograde pyelography was performed pre-operatively.

Main Results:

• An 80% success rate was observed, with marked or moderate shrinkage of dilated calices in 8 out of 10 patients.
• Seven cases showed marked shrinkage, and one showed moderate shrinkage.
• Two cases had no change; one underwent partial nephrectomy, and the other is under observation.
• One instance of pyelonephritis was the only significant complication.

Conclusions:

• Percutaneous endocalicotomy is a safe, less invasive, and parenchyma-saving procedure for renal tuberculosis strictures.
• Success is contingent on guidewire passage through the stricture.
• Pre-operative retrograde pyelography is crucial due to potential stricture worsening during chemotherapy.