Pyelocaliceal diverticula sometimes give rise to complications such as lithiasis or infection requiring surgical treatment. In addition to various open surgical techniques there is the possibility of percutaneous surgery. This short series of nine cases collected in 2 years covers a complete review of the different therapeutic possibilities.

The purpose of this study is to describe the technical modalities and to evaluate the results of percutaneous renal surgery for ureteropelvic stenosis, pyelocaliceal diverticula, renal cysts and urothelial tumors of the kidney. Based on a review of literature and although the number of the reported cases is limited, the results indicate a great deal of variability in the success of these technics depending on the pathology.

A survey of 107 patients treated for bladder papillomatosis, 78 of which recurred, confirmed the frequency of appearance of an iatrogenic reflux (28 cases: 26%). The main explanations for its onset are resection and orificial sclerosis. Two consequences of reflux are discussed. One is very probable: the development of tumoral lesions in the upper excretory pathways. Noted in 7 (25%) of the 28 cases, these high tumors can be partly explained by the mechanism of cell implantation, grafts being ascending in cases of reflux. A relation between severity of reflux and site of secondary tumor was not found (6 unilateral and 1 bilateral tumor). This was also true for the effect of the bladder lesion stage on frequency of high localizations. The second possible consequence of reflux, the subject of much greater debate, concerns the increased risk of toxicity from local chemotherapy which could lead to increase in the time and area of contact. This risk appears to be very low (2 interruptions of therapy in 10 patients treated with Thiotepa, none with mitomycin). Diagnosis of reflux affects treatment of the bladder tumor. When reflux is associated with high lesions, treatment of the tumor is the first imperative and is dependent on the manner in which it is conceived. When reflux is isolated, its surgical correction with the aim of preventing development of a pyelo-ureteral tumor is not widely accepted, since the condition of the patient and the course of the bladder disease must be taken into consideration.

Steroid therapy has been used as a treatment for idiopathic retroperitoneal fibrosis for the past ten years and more. In 14 out of a series of 19 patients, this treatment was well-tolerated and successful. It acts quickly. The results of medical treatment compare favorably with those of surgical ureterolysis. In the authors' view, steroid therapy is therefore the treatment of choice for this complaint, and surgical management should be confined to the relatively rare setbacks of medical treatment, and to patients who do not tolerate steroids.