The pediatric caliceal diverticulum: diagnosis and laparoscopic management.
OBJECTIVE
To describe the laparoscopic management of anterior caliceal diverticula in pediatric patients and to emphasize the importance of intraoperative retrograde pyelography for the diagnosis of symptomatic lesions when preoperative radiologic evaluation is inconclusive.


METHODS
We performed laparoscopic transperitoneal excision of a large symptomatic caliceal diverticulum in three patients. Ultrasonography was consistent with a cyst, and a CT scan did not show layering on delayed images. Prior to surgical intervention, we localized the diverticulum by cystoscopy and fluoroscopic retrograde ureteropyelography.


RESULTS
Complete ablation of the caliceal diverticulum cavity was achieved in all cases without open conversion. The mean operative time was 134 minutes. Blood loss was minimal in all cases. The mean hospital stay was 37 hours. There were no intraoperative or postoperative complications. Because the preoperative studies were consistent with large anterior cysts, we found retrograde ureteropyelography as an adjunct to laparoscopic surgery invaluable to identify the patent diverticular neck.


CONCLUSIONS
Patients with a large, symptomatic Type 2 caliceal diverticulum with thin overlying parenchyma are ideal candidates for laparoscopic intervention. The laparoscopic technique of caliceal diverticulum ablation in the pediatric population is feasible in appropriate patients.
Casale
Pasquale
P
Division of Pediatric Urology, Seattle Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington, USA. drcasale@hotmail.com
Grady
Richard W
RW
Feng
Waldo C
WC
Joyner
Byron D
BD
Mitchell
Michael E
ME
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D004240:Diverticulum / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007670:Kidney Calices; D007674:Kidney Diseases / Q000175:diagnosis* / Q000601:surgery*; D010535:Laparoscopy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014567:Urography