Department of Urology, Mount Sinai West, New York, New York.
Department of Urology, Mount Sinai West, New York, New York.
J Urol. 2017 Oct;198(4):864-868. doi: 10.1016/j.juro.2017.05.007. Epub 2017 May 5.
We evaluated the outcomes of percutaneous treatment and metabolic evaluation of calyceal diverticula with associated stones.
We retrospectively identified 51 patients with a calyceal diverticulum in our prospectively maintained percutaneous nephrolithotomy database. Patients with complete data were separated into 14 with stones isolated to the diverticulum and 15 with renal stones in and outside the diverticulum. A total of 571 patients with renal stones but no diverticulum were used for comparison. Statistical differences were assessed using the chi-square test and the t-test.
Patients with stones isolated to the diverticulum were younger (44 vs 54 years, p = 0.024), had a lower body mass index (23.2 vs 27 kg/m, p = 0.032) and were more often female (71% vs 44%, p = 0.046) compared to patients with renal stones but no diverticulum. Calyceal diverticula were anterior in 19 of 29 cases and in the upper pole in 15. Average diverticular size was 2.5 cm with a 1.5 cm stone burden. Percutaneous treatment was successful in 96% of patients with a 4% complication rate. The diverticular neck was dilated in 22 of 51 patients (43%). During 5-year followup in the 51 patients there was 1 stone recurrence, which was managed by ureteroscopy, while 46 and 5 patients showed complete absence and reduction of the diverticulum, respectively. Of the calyceal diverticular stones 82% contained calcium phosphate compared to only 33% in patients with renal stones but no diverticulum. All patients with a diverticulum had at least 1 metabolic derangement.
Percutaneous treatment of calyceal diverticula is safe and effective regardless of size or location, including anterior diverticula. Infundibular neck dilation does not appear to be necessary. There are metabolic abnormalities in a significant proportion of patients with a calyceal diverticulum.
我们评估了经皮治疗合并结石的肾盏憩室的疗效和代谢评估。
我们回顾性分析了前瞻性维持的经皮肾镜取石术数据库中 51 例肾盏憩室患者。将资料完整的患者分为 14 例单纯憩室结石和 15 例憩室内外肾结石。共 571 例无憩室肾结石患者作为对照。采用卡方检验和 t 检验评估统计学差异。
单纯憩室结石患者更年轻（44 岁比 54 岁，p = 0.024），体质量指数更低（23.2kg/m2 比 27kg/m2，p = 0.032），女性更多（71%比 44%，p = 0.046）。29 例憩室中有 19 例位于前位，15 例位于上极。平均憩室大小为 2.5cm，结石负荷为 1.5cm。96%的患者经皮治疗成功，并发症发生率为 4%。51 例患者中 22 例（43%）憩室颈扩张。51 例患者在 5 年随访期间，有 1 例结石复发，经输尿管镜处理，46 例和 5 例患者的憩室完全消失和缩小。与无憩室肾结石患者相比，肾盏憩室结石中 82%含有磷酸钙，而无憩室肾结石患者中只有 33%含有磷酸钙。所有有憩室的患者都至少有一种代谢异常。
经皮治疗肾盏憩室安全有效，无论大小和位置，包括前位憩室。漏斗颈扩张似乎不是必需的。有相当一部分肾盏憩室患者存在代谢异常。
