From the Research
The management of pelvocalyceal prominence should prioritize watchful waiting with periodic ultrasound monitoring every 6-12 months for asymptomatic mild to moderate cases, while obstructive cases may require ureteral stent placement, nephrostomy tube insertion, or surgical intervention such as ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), or percutaneous nephrolithotomy (PCNL) based on the underlying cause and severity. The approach to managing pelvocalyceal prominence depends on its cause, severity, and associated symptoms. For cases due to urinary tract obstruction, particularly those caused by kidney stones, treatment focuses on relieving the blockage. According to the study by 1, ESWL is a minimally invasive technique for fragmenting urinary tract stones, and its success depends on the indication, including stone size and composition, as well as the clinical context. For obstruction caused by kidney stones, management includes:
- Pain control with NSAIDs (ibuprofen 400-600mg every 6-8 hours) or opioids if needed
- Adequate hydration (2-3 liters of water daily)
- Medical expulsive therapy with alpha-blockers like tamsulosin 0.4mg daily to facilitate stone passage Larger stones (>6mm) or those causing persistent obstruction may require surgical intervention. A meta-analysis by 2 comparing flexible ureteroscopy (FURS), ESWL, and PCNL for lower pole stones of 10-20mm found that PCNL provided a higher stone-free rate than FURS and ESWL, suggesting that PCNL may be preferred for larger stones. However, the choice of intervention should also consider the stone's characteristics, such as density and size, as these factors significantly affect the success rate of ESWL, as shown by 3. Understanding the pelvicalyceal system's anatomy and its variations, as discussed in 4, can also improve the development and application of endourological techniques. Given the advancements in minimally invasive treatments, the most recent and highest quality evidence supports a personalized approach to managing pelvocalyceal prominence, considering the specific characteristics of the patient and the stone, as well as the potential benefits and risks of each treatment option.