Skip to main content

Advertisement

SpringerLink
Log in

Treatment Options for Calyceal Diverticula

  • Endourology (P Mucksavage and B Somani, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Calyceal diverticula are rare entities that can pose a significant challenge when it comes to their management. We analyse and summarise the literature with a focus on recent advances in the management of calyceal diverticula and discuss the advantages and disadvantages of each surgical technique.

Recent Findings

The identification of calyceal diverticula requires a certain level of suspicion and contrast-enhanced imaging. Conventional techniques of imaging the renal collecting system such as the classic intravenous urography are now superseded by the ease of access to contrast-enhanced CT imaging. Conventional surgical techniques for managing calyceal diverticula are not being superseded by new techniques but rather being progressively enhanced and improved through the amelioration of existing technology. Debate still exists over the best treatment approach for the management of symptomatic calyceal diverticula, the choice of which still very much depends on the location and anatomy of the diverticulum itself.

Summary

The most significant advance in the management of calyceal diverticula and indeed stones, in general, seems to be the progressive miniaturisation of percutaneous nephrolithotomy (PCNL) equipment allowing effective treatment with a reduction in associated risks of conventional PCNL. The increasing accessibility of robotics has a role to play in the management of this condition but is not likely surpass flexible ureteroscopic (fURS) or percutaneous approaches.

The future of surgical management for this condition lies in striking a balance between treatment efficacy and invasiveness. More recent identification of metabolic disturbances in patients with calyceal diverticular stones may provide further insights into the underlying pathology of this condition and is likely to play a role in future research of diverticular stones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Timmons JW Jr, Malek RS, Hattery RR, Deweerd JH. Caliceal diverticulum. J Urol. 1975;114(1):6–9.

    Article  Google Scholar 

  2. Waingankar N, Hayek S, Smith AD, Okeke Z. Calyceal diverticula: a comprehensive review. Rev Urol. 2014;16(1):29–43.

    PubMed  PubMed Central  Google Scholar 

  3. Wulfsohn MA. Pyelocaliceal diverticula. J Urol. 1980;123(1):1–8.

    Article  CAS  Google Scholar 

  4. Mullett R, Belfield JC, Vinjamuri S. Calyceal diverticulum - a mimic of different pathologies on multiple imaging modalities. J Radiol Case Rep. 2012;6(9):10–7. https://doi.org/10.3941/jrcr.v6i9.1123.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dretler S. A new useful endourologic classification of calyceal diverticula. J Endourol. 1992;6.

  6. • Ito H, Aboumarzouk O, Abushamma F, Keeley F. Systematic review of Calyceal Diverticulum. J Endourol. 2018;32:961–72. https://doi.org/10.1089/end.2018.0332 Recent systematic review comparing surgical treatment modalities.

    Article  PubMed  Google Scholar 

  7. Canales B, Monga M. Surgical management of the calyceal diverticulum. Curr Opin Urol. 2003;13(3):255–60. https://doi.org/10.1097/01.mou.0000068754.22370.89.

    Article  PubMed  Google Scholar 

  8. Turna B, Raza A, Moussa S, Smith G, Tolley DA. Management of calyceal diverticular stones with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy: long-term outcome. BJU Int. 2007;100(1):151–6. https://doi.org/10.1111/j.1464-410X.2007.06911.x.

    Article  PubMed  Google Scholar 

  9. Chong TW, Bui MH, Fuchs GJ. Calyceal diverticula: ureteroscopic management. Urol Clin North Am. 2000;27(4):647–54.

    Article  CAS  Google Scholar 

  10. Zhang JQ, Wang Y, Zhang JH, Zhang XD, Xing NZ. Retrospective analysis of ultrasound-guided flexible ureteroscopy in the management of calyceal diverticular calculi. Chin Med J. 2016;129(17):2067–73. https://doi.org/10.4103/0366-6999.189060.

    Article  PubMed  PubMed Central  Google Scholar 

  11. • Parkhomenko E, Tran T, Thai J, Blum K, Gupta M. Percutaneous management of stone containing calyceal diverticula: associated factors and outcomes. J Urol. 2017;198(4):864–8. https://doi.org/10.1016/j.juro.2017.05.007 Recent series concluding that all patients withcalyceal divarticula have at least one metabolic disturbance.

    Article  PubMed  Google Scholar 

  12. • Bas O, Ozyuvali E, Aydogmus Y, Sener NC, Dede O, Ozgun S, et al. Management of calyceal diverticular calculi: a comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy. Urolithiasis. 2015;43(2):155–61. https://doi.org/10.1007/s00240-014-0725-5 Recent series comparing PCNL to fURS in the management of calyceal diverticular stones.

    Article  PubMed  Google Scholar 

  13. • Jones P, Bennett G, Dosis A, Pietropaolo A, Geraghty R, Aboumarzouk O, et al. Safety and efficacy of day-case percutaneous nephrolithotomy: a systematic review from European Society of Uro-technology. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2018.04.002 Review introducing the concept of and considering the safety of day case PCNL.

  14. Fahmy A, Rhashad H, Algebaly O, Sameh W. Can percutaneous nephrolithotomy be performed as an outpatient procedure? Arab J Urol. 2017;15(1):1–6. https://doi.org/10.1016/j.aju.2016.11.006.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Silay MS, Koh CJ. Management of the bladder and calyceal diverticulum: options in the age of minimally invasive surgery. Urol Clin North Am. 2015;42(1):77–87. https://doi.org/10.1016/j.ucl.2014.09.007.

    Article  PubMed  Google Scholar 

  16. Bonastre C, Briones G. Laparoscopic calyceal diverticulectomy. Cent Eur J Urol. 2016;69(3):313. https://doi.org/10.5173/ceju.2016.805.

    Article  Google Scholar 

  17. Sripathi V, Mitra A, Padankatti RL, Ganesan T. Robotic treatment of a type 2 calyceal diverticulum in a child: is suture closure and marsupialisation enough for a good outcome? J Robot Surg. 2017;12:727–30. https://doi.org/10.1007/s11701-017-0758-1.

    Article  PubMed  Google Scholar 

  18. Nakano T, Kitagawa Y, Izumi K, Ikeda H, Namiki M. Invasive urothelial carcinoma within a calyceal diverticulum associated with renal stones: a case report. Oncol Lett. 2015;10(4):2439–41. https://doi.org/10.3892/ol.2015.3590.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Chen YW, Shen SH, Chang YH, Pan CC. Squamous cell carcinoma arising from a renal calyceal diverticulum. Urology. 2016;95:e5–6. https://doi.org/10.1016/j.urology.2016.05.055.

    Article  PubMed  Google Scholar 

  20. Matlaga BR, Miller NL, Terry C, Kim SC, Kuo RL, Coe FL, et al. The pathogenesis of calyceal diverticular calculi. Urol Res. 2007;35(1):35–40. https://doi.org/10.1007/s00240-007-0080-x.

    Article  CAS  PubMed  Google Scholar 

  21. Auge BK, Maloney ME, Mathias BJ, Pietrow PK, Preminger GM. Metabolic abnormalities associated with calyceal diverticular stones. BJU Int. 2006;97(5):1053–6. https://doi.org/10.1111/j.1464-410X.2006.06134.x.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Hospital Monklands, Monkscourt avenue, Airdrie, ML60JS, UK

    Niamh Smyth

  2. University Hospital Southampton, Southampton, UK

    Bhaskar Somani

  3. Newcastle Freeman Hospital, Newcastle upon Tyne, UK

    Bhavan Rai

  4. Glasgow Urological Research and Training Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK

    Omar M Aboumarzouk

  5. School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK

    Omar M Aboumarzouk

Authors
  1. Niamh Smyth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bhaskar Somani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bhavan Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omar M Aboumarzouk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Niamh Smyth.

Ethics declarations

Conflict of Interest

Niamh Smyth, Bhavan Rai and Omar M. Aboumarzouk each declare no potential conflicts of interest.

Bhaskar Somani is a section editor for Current Urology Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Endourology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smyth, N., Somani, B., Rai, B. et al. Treatment Options for Calyceal Diverticula. Curr Urol Rep 20, 37 (2019). https://doi.org/10.1007/s11934-019-0900-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-019-0900-x

Keywords

Search

Navigation