Endourologic management of stone-bearing excluded calices: contrasting case reports

Calculi in a noncommunicating or excluded calix may be associated with infection, pain, and focal renal damage. Some authors have recommended removal of these calculi and reestablishment of the pelvicaliceal communication, either by dilation of the infundibulum or creation of a neoinfundibulum, in order to prevent recurrent stone formation and infection. Herein, we report two patients with stones in a completely excluded calix, one after repeated courses of shockwave lithotripsy for a staghorn calculus and the other after recurrent pyelonephritis. The combined approach is especially helpful if the examiner is in doubt about the anatomy (true calix v caliceal diverticulum) or if a natural infundibulum cannot be identified by antegrade endoscopy.