Kidney Stones Clinical Trial
Official title:
Percutaneous Surgical Outcomes and Metabolic Findings in Patients With Stone-Bearing Calicial Diverticula
Historically, percutaneous treatment of stone-bearing caliceal diverticula has resulted in the best success rates when examining factors such as symptom relief and stone-free rates (Jones, et al, 1991). Many groups have reported modifications in their percutaneous approach which have reportedly improved patient outcomes, but these series have very limited populations. Another issue concerning stone-bearing caliceal diverticula centers on the etiology of stones formation within these areas. This topic remains a subject of debate, with conflicting data in the literature.
Caliceal diverticula are non-secretory cavities which are connected to the remainder of the
renal collecting system through narrow infundibulae. Calculi are associated with these
cavities from 9.5 to 78% of cases (Liatsikos, et al 2000; Monga, et al 2000). This subset of
stone-forming patients often presents with recurrent urinary tract infections and flank
discomfort. The definitive treatment for this entity remains surgical, with shock wave
lithotripsy (SWL), ureteroscopy (URS), percutaneous nephrolithotomy (PNL), and laparoscopy
all serving as management options. However, multiple groups have demonstrated that PNL
remains the treatment modality of choice secondary to its superior stone-free and symptom
relief rates (Jones, et al 1991; Donnellan, et al 1999; Shalhav, et al 1998). Over time,
technique modifications have been reported by other groups (Monga, et al 2000; Auge, et al
2002) involving different methods of managing the infundibulum that connects the
diverticulum to the rest of the renal collecting system. Our own surgical experience with
percutaneous treatment of stone-bearing caliceal diverticula has resulted in various
technique modifications as well, which we believe have continued to improve patient
outcomes. To support our hypothesis, we will need to perform a systematic review our patient
population to document these surgical outcomes.
Another question surrounding this subset of patients involves the primary factor responsible
for the formation of calculi within the diverticula. Unfortunately, the literature has
provided conflicting data on this issue. Some groups attribute stone formation to underlying
metabolic abnormalities (Hsu, et al 1998). Other groups have not found any metabolic
problems, instead concluding that impaired urinary drainage from the diverticulum primarily
contributes calculus formation (Liatsikos, et al 2000). By prospectively obtaining urines on
our caliceal diverticula patients, we hope that detailed metabolic analyses will allow us to
conclude definitively whether metabolic abnormalities are prevalent in this population.
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Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Prevention
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