Niamh Smyth1, Bhaskar Somani2, Bhavan Rai3, Omar M Aboumarzouk4,5. 1. University Hospital Monklands, Monkscourt avenue, Airdrie, ML60JS, UK. n.p.smyth@gmail.com. 2. University Hospital Southampton, Southampton, UK. 3. Newcastle Freeman Hospital, Newcastle upon Tyne, UK. 4. Glasgow Urological Research and Training Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK. 5. School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.
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 Conventional techniques of imaging the renal collecting system such as the classic intravenous urography are now superseded by the ease of access to contrast-enhanced CT imaging. Conventional surgical techniques for managing calyceal diverticula are not being superseded by new techniques but rather being progressively enhanced and improved through the amelioration of existing technology.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. 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.
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. 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.