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Chopra P, Cleveland CH, Johnson M, Michell H, Holoch P, Irwin B, Scriver GM, Morris CS. Creation of a neoinfundibulum and serial balloon dilations for the treatment of the excluded calyx: Two cases describing a novel technique. Radiol Case Rep 2020; 15:1121-1127. [PMID: 32509047 PMCID: PMC7265071 DOI: 10.1016/j.radcr.2020.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/05/2022] Open
Abstract
An excluded calyx is a rare, acquired urologic condition where there is discontinuity between a portion of the renal collecting system with the remainder of the collecting system. Re-establishment of reliable long-term communication between the excluded calyx and the remaining collecting system is crucial for preservation of renal function and possible relief of symptoms. In this manuscript, we discuss two such cases where a previously undescribed novel procedure is used for treatment of this uncommon condition, where percutaneous antegrade transcatheter techniques were used to establish long-term urinary drainage. The first case discusses an excluded calyx in a 17-year-old male who suffered left renal injury after a high speed motor vehicle accident, where the kidney was divided by the injury and subsequently required creation of a neoinfundibulum in order to maintain continuity of the collecting system. The second case involves a 39-year-old female who underwent resection of a renal cell carcinoma, later developing an excluded calyx where radiofrequency wire recanalization was performed and the neoinfundibular track underwent serial retrograde balloon dilation, resulting in a continuous collecting system. Both patients have done well for more than 2 years after neoinfundibulum creation, showing that this novel technique should be considered a viable and safe procedure in the treatment of this rare condition.
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Affiliation(s)
- Prajna Chopra
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
| | | | - Mark Johnson
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Hans Michell
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
| | - Peter Holoch
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Brian Irwin
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Geoffrey M Scriver
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
| | - Christopher S Morris
- University of Vermont College of Medicine, Burlington, VT, USA.,Interventional Radiology, Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA
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Williams SK, Atalla C, Ghavamian R, Stein C, Hoenig DM. "Extreme" renal preservation: neoadjuvant chemotherapy and percutaneous resection for upper-tract urothelial carcinoma in a patient with solitary kidney--a case report. J Endourol 2013; 27:427-31. [PMID: 23442142 DOI: 10.1089/end.2012.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Renal preservation in selected patients with upper-tract urothelial cancer (UTUC) has been well described, offering an alternative to radical nephroureterectomy. We present our experiences in performing percutaneous treatments after neoadjuvant chemotherapy in one such patient with a large, complex, high-grade UTUC in a solitary kidney. CASE REPORT A 55-year-old woman with a solitary kidney presented with a 5.2 cm enhancing mass with calcifications involving the left renal pelvis and lower pole. Cystoscopy and retrograde pyelography demonstrated normal bladder mucosa. Ureteroscopy revealed a large, papillary tumor occupying the renal pelvis. Ureteroscopic treatment was deemed impossible because of the lesion's volume. We proceeded with percutaneous resection after downsizing the tumor after a course of neoadjuvant chemotherapy. Using a 25F resectoscope via a percutaneous tract, resection was performed to fully excise the tumor, and the patient received two postoperative chemotherapy courses. A recurrence developed within an isolated calix 8 months postoperatively, which was also managed percutaneously. CONCLUSION A multimodal approach in a highly motivated patient could represent a reasonable strategy for patients in whom such a therapy is desired.
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Affiliation(s)
- Steve K Williams
- Department of Urology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
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Goel A, Goel A, Dalela D. Excluded Calyx Following Percutaneous Nephrolithotomy: A Rare Complication. Indian J Surg 2013; 75:56-8. [DOI: 10.1007/s12262-012-0434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 03/04/2012] [Indexed: 10/28/2022] Open
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Mues AC, Landman J, Gupta M. Endoscopic Management of Completely Excluded Calices: A Single Institution Experience. J Endourol 2010; 24:1241-5. [DOI: 10.1089/end.2009.0663] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Adam C. Mues
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mantu Gupta
- Department of Urology, Columbia University Medical Center, New York, New York
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Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy has undergone an evolution in technique and in equipment since its introduction in the late 1970s. This evolution continues today and is evidenced by the numerous publications about the technique. This review summarizes some of the important articles over the past year. RECENT FINDINGS Although ureteroscopy and shock wave lithotripsy predominate in the treatment of urolithiasis, percutaneous nephrolithotomy continues to play an important role. Percutaneous nephrolithotomy is advantageous as it causes minimal renal injury and maximizes stone clearance, especially in patients with complex stone disease. Although nephrostomy drainage tubes have always been placed after percutaneous nephrolithotomy, there may be specific indications for tubeless percutaneous nephrolithotomy. SUMMARY Percutaneous nephrolithotomy continues to be an important part of the urologist's armamentarium. Recent studies have redefined the role of percutaneous nephrolithotomy and future studies will further delineate the importance of this procedure in the treatment of urolithiasis.
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Affiliation(s)
- Samuel C Kim
- Methodist Hospital Institute for Kidney Stone Disease and Indiana University School of Medicine, Indianapolis, Indiana, USA
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