Thời gian nằm viện trung bình là 2,8 ngày, và tất cả các bệnh nhân được xuất viện về nhà với một ống nephrostomy 22-Cha đã được gỡ bỏ 1 tuần sau đó. Trong phim được công bố, tỷ lệ chung đá miễn phí và triệu chứng của 89 và 89%, tương ứng, đã đạt được (Bảng 2). Hơn nữa, trong 60% trường hợp, diverticula thành công xóa sạch. | Chapter 14 Caliceal Diverticula 247 with tube thoracostomy. The average hospital stay was days and all patients were discharged home with a 22-Fr nephrostomy tube that was removed 1 week later. In published series overall stone-free and symptom-free rates of 89 and 89 respectively have been achieved Table 2 . Furthermore in 60 of cases the diverticula were successfully obliterated. For caliceal diverticula approached directly the overall success rate obliteration of diverticulum was 63 88 139 vs indirectly which was 9 2 22 . Complication rates are slightly higher with a percutaneous approach 15 compared with a retrograde ureteroscopic approach 9 Tables 1 and 2 . Laparoscopic Approach A total of 13 cases of laparoscopic unroofing of caliceal diverticula have been reported in the literature including a transperitoneal approach in 1 case and a retroperitoneal approach in 12 cases 29-33 . Operative times ranged from 60 to 215 minutes and the overall complication rate was with the only reported complication consisting of bleeding requiring transfusion. Radiographic studies demonstrated obliteration of the diverticula in all 13 cases and all patients were rendered symptom free at a mean followup of 6 months. The laparoscopic approach is generally reserved for large diverticula 5 cm or anteriorly located diverticula with thin overlying parenchyma. TIPS AND TRICKS Ureteroscopic Approach Contrast injected through the ureteroscope helps to identify the calyx with which the diverticulum is associated. Passage of a guidewire into the diverticula confirms proper identification of the ostium and opens up the diverticular neck sufficiently to position a laser fiber for incision. Dilation of the diverticular neck after incision separates the incised edges and facilitates clearance of stones fragments from the diverticulum. Percutaneous Approach After percutaneous puncture a moveable core guidewire or J-wire coiled within the diverticulum provides moderately secure .
