Percutaneous infundibuloplasty: management of calyceal diverticula and infundibular stenosis.

Abstract

Calculi in calyceal diverticula or behind stenotic renal infundibula are generally managed with percutaneous extraction. Percutaneous infundibuloplasty, a relatively noninvasive technique, is advocated to drain and eradicate the potentially infected space and can be performed at the same time as stone extraction. A communication between the diverticulum and renal pelvis is created by passing a transjugular cholangiographic needle under fluoroscopic or visual guidance, dilating the tract with a balloon catheter, and placing a stent until uroepithelial coverage has occurred. Stenotic infundibula are dilated in a like fashion. During 7 years, six (60%) of 10 patients with such "neoinfundibula" draining calyceal diverticula remained patent for at least 2 years. In two more patients (20%), both the calyceal diverticular cavity and neoinfundibulum were obliterated; in only one patient (10%) was there a residual cavity after the neoinfundibulum became obstructed. One patient was lost to follow-up. Long-term correction of infundibular stenoses was achieved with this technique in four (67%) of six patients, and there were no renal or perirenal abscesses.