What is pelvocaliectasis and its treatment?

Pelvocaliectasis: Definition and Treatment

Pelvocaliectasis is a dilation of the renal pelvis and calyces of the kidney, and treatment involves addressing the underlying cause through medical management (hydration, analgesia, antibiotics if infected) or interventional procedures (decompression via percutaneous nephrostomy or ureteral stenting) depending on severity and etiology. 1

Definition and Diagnosis

Pelvocaliectasis refers to dilation of the renal pelvis and calyces within the kidney's collecting system. It is often detected as an incidental finding on imaging studies but can be associated with various underlying conditions:

• It appears as a finding in approximately 3.9% of patients undergoing ultrasound after urinary tract infections 2
• It may be part of a spectrum of urinary tract dilation that ranges from mild pyelectasis to more severe hydronephrosis

Diagnostic Approach

• Ultrasonography is the first-line imaging modality to confirm and assess severity
• Additional imaging (CT or MRI) may be needed to determine the underlying etiology
• Renal function tests should be performed to evaluate kidney function 1

Treatment Approach

Treatment of pelvocaliectasis depends on:

1. Underlying cause
2. Severity of dilation
3. Presence of complications (infection, obstruction)
4. Impact on renal function

Medical Management

For mild to moderate uncomplicated pelvocaliectasis:

• Adequate hydration to promote urine flow
• Analgesics for pain relief
• Close monitoring with serial ultrasound examinations
• Antibiotics if urinary tract infection is present 1

Interventional Management

For severe or complicated pelvocaliectasis (with obstruction or infection):

• Decompression of the collecting system is the primary intervention
• Options include:
  • Percutaneous nephrostomy (PCN) - preferred for infected systems
  • Retrograde ureteral stenting 1

Surgical Management

Surgical correction may be required for specific causes:

• Open pyeloplasty shows high success rates (82.6%) for ureteropelvic junction obstruction in ectopic pelvic kidneys 3
• Endourologic techniques can be used to relocate laterally inserting ureters in cases of ureteropelvic junction obstruction 4
• Ureterocalicostomy may be performed for recurrent obstruction or cases with unfavorable anatomy 5

Follow-up and Monitoring

• Serial ultrasound examinations to assess resolution of dilation
• Regular renal function tests to monitor kidney function
• Follow-up imaging frequency based on underlying etiology and severity 1

Special Considerations

• In pediatric patients, isolated pyelectasis without caliceal involvement rarely constitutes a pathological situation and may not require specific intervention 6
• In cases of obstruction, prompt treatment is essential to prevent progressive deterioration of renal function
• The presence of ureterectasia requires evaluation for vesicoureteric reflux with micturitional cystourethrography 6

Pitfalls to Avoid

• Not distinguishing between physiologic dilation and pathologic obstruction
• Failing to identify and treat underlying causes
• Delaying intervention in cases with infection or significant obstruction
• Overlooking the need for regular follow-up, especially in cases with persistent dilation after treatment

Remember that pelvocaliectasis itself is a radiological finding rather than a diagnosis, and management should focus on identifying and treating the underlying cause while preserving renal function.