What is the treatment for pelvocalicectasis?

Treatment of Pelvicaliectasis

The treatment of pelvocaliectasis requires a combined medical and urological approach, with management determined by the underlying cause and severity of the condition. 1

Diagnostic Approach

• Ultrasonography is the first-line imaging modality to confirm pelvocaliectasis and assess severity
• Additional imaging may be needed:
  • CT scan or MRI to determine underlying etiology
  • Renal function tests to evaluate kidney function

Treatment Algorithm Based on Etiology

1. Obstructive Pelvocaliectasis

• Primary intervention: Decompression of the collecting system 2
  • Options include:
    • Percutaneous nephrostomy (PCN) - preferred for infected systems
    • Retrograde ureteral stenting - when feasible without infection
  • For ureteropelvic junction obstruction (UPJ):
    • Endourologic management with retrograde endopyelotomy 3
    • Pyeloplasty for definitive correction, especially in ectopic pelvic kidneys 4

2. Infectious Pelvocaliectasis

• Combined approach:
  • Appropriate antibiotics based on culture sensitivity
  • Drainage if significant obstruction present
  • For fungal infections: nephrostomy with amphotericin B instillation into the pelvocalyceal system 1

3. Physiologic Pelvocaliectasis (e.g., during pregnancy)

• Conservative management in most cases
• Medical management with adequate hydration, rest, and analgesia 2
• Intervention only if complicated by infection or significant obstruction

4. Congenital/Anatomic Pelvocaliectasis

• Surgical correction may be required:
  • Open pyeloplasty shows high success rate (82.6%) for ectopic pelvic kidneys 4
  • Early surgical intervention may be beneficial in severe neonatal cases 5

Follow-up and Monitoring

• Serial ultrasound examinations to assess resolution
• Renal function tests to monitor kidney function
• Follow-up imaging based on underlying etiology and severity

Important Considerations

• In cases with lateral insertion of the ureter causing UPJ obstruction, endourologic techniques can relocate the UPJ to a more favorable position 3
• Early intervention in severe neonatal pelvocaliectasis with poor function may lead to normalization of renal function 5
• Physiologic pelvocaliectasis during pregnancy typically doesn't require intervention unless complicated by infection 6

Pitfalls to Avoid

• Delaying intervention in infected systems, which can lead to sepsis
• Misattributing elevated resistivity index during pregnancy to physiologic changes when pathology may be present 6
• Overlooking the need for regular follow-up, especially after pyeloplasty for ectopic pelvic kidneys, as varying degrees of hydronephrosis may persist 4