Summary
Introduction
We report a rare case of four sequestered caliceal diverticula that failed previous
percutaneous sclerotherapy and were subsequently managed with robot-assisted laparoscopic
unroofing and fulguration of the sequestered diverticula cluster.
Methods
A 6 year-old female was admitted for urosepsis and flank pain. At age 2, a previous
institution diagnosed a caliceal diverticulum. Prolonged-delayed magnetic resonance
urography confirmed four sequestered caliceal diverticula. Intraoperative ultrasonography
identified the diverticula cluster and ensured decompression. The defects were closed
after ablating the blood supply, unroofing and decompressing the diverticula, and
fulgurating the caliceal lining.
Results
Console time was 4 h with an estimated blood loss of 30–50 cc. The patient was discharged
post-op day 3. Follow-up renal ultrasound at 6 weeks and 5 months demonstrated progressive
atrophy of the left upper pole with preservation of the lower pole size and perfusion.
At 9 months, the patient is free of symptoms and urinary tract infections.
Conclusion
Closure of unroofed and fulgurated diverticula may be considered when diverticula
are anatomically sequestered from the renal collecting system. Robotic-assisted laparoscopic
unroofing and fulguration is a technically feasible approach for treatment of sequestered
caliceal diverticula in pediatric patients. Additional studies and monitoring of long-term
renal function are required.
Keywords
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References
- Calyceal diverticula: a comprehensive review.Rev Urol. 2014; 16: 29-43
- Pediatric calyceal diverticulum treatment: an experience with endoscopic and laparoscopic approaches.J Pediatr Urol. 2015; 11https://doi.org/10.1016/j.jpurol.2015.04.013
Article info
Publication history
Published online: August 19, 2020
Accepted:
July 31,
2020
Received in revised form:
June 14,
2020
Received:
May 13,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
