Retroperitoneoscopic Technique for Treating Symptomatic Caliceal Diverticula

Abstract

Calculous disease in a caliceal diverticulum is a rare entity. The standard treatment currently is endoscopic surgery with marsupialization or fulguration or both with dilatation of the neck of the diverticulum. We present the fifth reported case of retroperitoneoscopic management of a caliceal diverticulum in a patient with a long history of flank pain and suggest that this treatment offers a stone-free rate comparable to that of open surgery with less morbidity than is associated with endoscopic treatments.

The Pediatric Caliceal Diverticulum: Diagnosis and Laparoscopic Management

“…10 Some cases of symptomatic caliceal diverticula managed laparoscopically have been reported. [2][3][4][5][6][7][8] The diverticula were generally treated by excision and fulguration. Use of perinephric fat or gelatin resorcinol formaldehyde glue to fill the cavity and seal the diverticular neck has been described.…”

“…However, laparoscopic management has been described in adults with excellent clinical outcomes. [2][3][4][5][6][7] Recently, Miller and associates 8 proposed an algorithm to help define the role of laparoscopy in the overall management of symptomatic caliceal diverticular calculi. Laparoscopy has recently been implemented in the mainstream of pediatric urology.…”

Percutaneous Management of Caliceal Diverticuli

“…Currently used minimally invasive treatment for patients with symptomatic caliceal diverticula includes shockwave lithotripsy (SWL), [17][18][19] ureteroscopy (URS), [20][21][22][23] percutaneous nephrolithotomy (PCNL), 16,17,20,[24][25][26][27][28][29][30] and laparoscopy. [31][32][33][34][35][36] SWL for the management of caliceal diverticula is an attractive but controversial minimally invasive treatment option. Although at short-term follow-up SWL can provide symptomatic pain relief in 36% to 70% of patients, stone-free rates are low, ranging from 4% to 20%.…”

Treatment of Caliceal Diverticula

“…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)(30)(31)(32)(33). Operative times ranged from 60 to 215 minutes, and the overall complication rate was 7.7%, with the only reported complication consisting of bleeding requiring transfusion.…”