[Calyceal diverticula : review of 80 diverticula in 70 patients (author's transl)]

The authors review 70 patients with calyceal diverticula, 20 of these patients had an associated urological congenital malformation and 7 of them a lithiasis. The majority of these diverticula were discovered by chance but complications in the form of pain (26 cases), fever (11 cases) or macroscopic haematuria were the essential presenting symptoms. Clinical manifestations occur in relation to large diverticula and, in particular, those containing calculi. Patients with lithiasis are far more often infected than the others. The latent nature of diverticula is such that the onset of clinical symptoms and signs (lumbar pain, fever and pyuria) should lead to a search for an associated malformation, in particular vesico-ureteric reflux and direct cystography is essential. The virtually sole complication of a calyceal diverticulum is lithiasis. 43 of the 90 diverticula studied contained one or more calculi. Infectious complications may result from those diverticula containing stones and are rare in the absence of lithiasis. Only 18 patients underwent surgery (20 diverticula) : 9 by partial nephrectomy (polar in 9 cases and cuneiform in 2), 6 simple incisions of the diverticulum and 2 excisions of the diverticulum. In view of the rarity of complications, it is evident that only poorly tolerated diverticula require operation. In the view of the authors, two essential surgical techniques should be used : polar nephrectomy and resertion of the diverticular protrusion with closure of the neck. Finally, in the presence of associated vesico-ureteric reflux, it is the symptoms and signs of the latter which must influence the choice of treatment. When necessary, it would appear preferable to start by the correction of reflux.