Surgical management of the calyceal diverticulum

The management of calyceal diverticulum has evolved from an open surgical approach to a minimally invasive approach. Currently, the percutaneous, ureteroscopic and laparoscopic techniques are recommended by individual investigators. Recent studies have helped establish patient selection criteria for each of the above procedures. This review will discuss technique and results and suggest a treatment algorithm for the patient with a symptomatic calyceal diverticulum.

Excellent long-term success has been reported with all three minimally invasive modalities. Percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique for this disorder. A direct puncture into the calyceal diverticulum is recommended. Limitations exist primarily for an anteriorly located diverticulum. In this situation, if the diverticulum is in a superior anterior calyx, a ureteroscopic approach is recommended while if the diverticulum is in a middle or lower pole calyx, a laparoscopic approach is recommended.

This review suggests that experience and expertise in percutaneous, ureteroscopic and laparoscopic techniques provide the urologist with the best opportunity to individualize treatment approach based on location and size of the diverticulum. A treatment algorithm based on these parameters may be helpful in patient counseling and decision-making.