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Caliceal diverticula in children: natural history and management
Carlos R Estrada1, Sanchari Datta, Francis X Schneck
1Department of Urology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Pediatric caliceal diverticula are rare, with most remaining stable. However, about 20% may enlarge symptomatically, necessitating surgical intervention and evaluation for vesicoureteral reflux.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Management
Background:
- Caliceal diverticula in children are uncommon.
- Their natural history and optimal management remain incompletely understood.
Purpose of the Study:
- To investigate the presentation, natural history, and management of caliceal diverticula in a pediatric cohort.
- To assess the need for surgical intervention and associated morbidities.
Main Methods:
- Retrospective review of 22 children with caliceal diverticula (1983-2006).
- Data collected included demographics, imaging, treatment, and clinical outcomes.
- Voiding cystourethrogram performed for all patients.
Main Results:
- 23 caliceal diverticula identified in 22 children (14 girls, 8 boys).
- Presentations varied: 10 with febrile UTI, 8 asymptomatic.
- 43% required treatment for symptomatic enlargement, calculus, abscess, or urosepsis; 57% remained stable and asymptomatic with observation.
Conclusions:
- Caliceal diverticula in children are rare but can lead to significant morbidity.
- Approximately 20% experience symptomatic enlargement requiring surgery.
- Mandatory evaluation for ipsilateral vesicoureteral reflux is recommended due to associated risks.
Purpose:
The natural history of caliceal diverticula in children is unknown. We review our series of children with caliceal diverticula to examine the presentation, natural history and management.
Materials And Methods:
We retrospectively reviewed the records of 22 children presenting with caliceal diverticula between 1983 and 2006. All pertinent clinical data were recorded, including demographics, imaging studies, treatment and clinical outcome.
Results:
A total of 22 children had 23 caliceal diverticula. There were 14 girls and 8 boys who presented at a mean age of 5.4 +/- 3.1 years (range 0.2 to 12). At clinical presentation 10 patients had febrile urinary tract infection, 2 had hematuria, 2 had abdominal pain, 1 had flank pain and 8 were asymptomatic. Mean diameter of all caliceal diverticula was 2.2 +/- 1.7 cm. All patients underwent voiding cystourethrogram. Two patients (9%) had concomitant ipsilateral caliceal diverticula and vesicoureteral reflux. A total of 10 patients with caliceal diverticula (43%) were treated at a mean of 3.0 +/- 2.3 years after initial presentation due to symptomatic enlargement in 5, symptomatic calculus in 3, complicated abscess in 1 and urosepsis in 1. Treatment modalities included percutaneous ablation, open marsupialization/ablation, partial nephrectomy and laparoscopic marsupialization/ablation. There were no recurrences during a mean followup of 3.1 +/- 2.9 years (range 0.1 to 10.1) in these 10 patients. In the 13 caliceal diverticula (57%) that were observed mean followup was 6 +/- 3.7 years (range 1.2 to 10.5). These caliceal diverticula were stable in size and remained asymptomatic.
Conclusions:
Caliceal diverticula in children are rare. Most caliceal diverticula remain stable and asymptomatic but approximately 20% may have symptomatic enlargement that may warrant surgical management. Given the morbidity associated with caliceal diverticula and concomitant vesicoureteral reflux, evaluation for ipsilateral reflux is mandatory. Overall approximately 43% of children with caliceal diverticula require surgical intervention, and various treatment options are available.
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