Symptomatic caliceal diverticula treated with extraperitoneal laparoscopic marsupialization fulguration and gelatin resorcinol formaldehyde glue obliteration.
OBJECTIVE
The treatment of symptomatic stone filled caliceal diverticula has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy, percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. We describe a laparoscopic technique for the management of symptomatic caliceal diverticula.


METHODS
An extraperitoneal laparoscopic procedure was done in 3 women with symptomatic caliceal diverticula. Watertight obliteration of the diverticular cavity was achieved without suturing, using gelatin resorcinol formaldehyde glue.


RESULTS
Average operating time was 80 minutes, including ureteral catheterization. All patients became stone-free, there were no complications and average hospital stay was 6.6 days. At 6-month followup the patients remained asymptomatic with no diverticula or stone recurrence.


CONCLUSIONS
Retroperitoneoscopy allows safe access to caliceal diverticula regardless of location, and permits complete removal of stone and fulguration of the diverticular neck. Gelatin resorcinol formaldehyde glue minimizes the risk of urinoma formation, and provides a simple, quick and safe alternative for nephrotomy closure.
Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
A
A
Hoznek
A
A
Herard
N
N
Ogiez
D
D
Amsellem
D K
DK
Chopin
C C
CC
Abbou
D000293:Adolescent; D000328:Adult; D004240:Diverticulum / Q000601:surgery*; D004338:Drug Combinations; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000627:therapeutic use*; D005780:Gelatin / Q000627:therapeutic use*; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D007670:Kidney Calices / Q000601:surgery*; D007674:Kidney Diseases / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008096:Lithotripsy; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000517:prevention & control; D012118:Resorcinols / Q000627:therapeutic use*; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D018666:Ureteroscopy; D014546:Urinary Catheterization; D014556:Urine
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin