Treatment of Caliceal Diverticula

Caliceal diverticula represent a therapeutic challenge for the endourologist. Treatment options for symptomatic, stone-bearing, caliceal diverticula include shockwave lithotripsy (SWL), ureteroscopy, percutaneous nephrostolithotomy/ablation, and laparoscopic unroofing. A surprising number of patients achieve symptomatic relief despite poor stone-free rates with SWL, although this approach is best reserved for patients with a small stone burden in a diverticulum with a widely patent neck. Ureteroscopic management (consisting of laser endoinfundibulotomy or balloon dilation of the infundibular neck and fragmentation/removal of the stones) is a good option for relatively small, upper or middle caliceal diverticula with stones less than 15 mm in size. The percutaneous approach is associated with the highest stone-, symptom-, and diverticulum-free rates and is the optimal treatment for all but anteriorly located diverticula. Lastly, laparoscopy is reserved for large, anteriorly positioned diverticula or diverticula that fail endourological management.