Ito H, Aboumarzouk O, Abushamma F, Keeley F.
Southmead Hospital, 159003, Bristol Urological Institute, Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland.
Queen Elizabeth University Hospital, 473300, Urology Department, Urological Research and Training Unit, Glasgow, United Kingdom of Great Britain and Northern Ireland.
University of Glasgow, School of Medicine, Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland.
Bristol Urological Institute, Urology, Southmead Hospital, Westbury-on-Trym, Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland.

Abstract

PURPOSE: We performed a systematic review of the literature regarding the diagnosis and treatment of calyceal diverticulum (CD).
METHODS: The search strategy was conducted according to the Cochrane reviews guidelines for systematic reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. RESULTS: In total 1189 titles and abstracts were reviewed, of which 101 were selected for manuscript evaluation. Of these 101 papers, 40 were selected for inclusion after full manuscript evaluations. In the extracted papers, intravenous urography (IVU) rather than CT urography was the main imaging tool for diagnosis, although many papers had failed to provide any imaging modality information. Extracted papers involved 88, 153 and 487 patients who underwent shock wave lithotripsy (SWL), flexible ureteroscopy/retrograde intrarenal surgery (fURS / RIRS) and percutaneous nephrolithotomy (PCNL), respectively. Stone free rate were 21.3% (SWL), 61.4% (fURS/RIRS) and 83.0% (PCNL). The complication rates were 8.0% (SWL), 3.3% (fURS/RIRS) and 11.9% (PCNL). There was incomplete and inconsistent reporting of even basic clinical parameters such as the size and location of the CD, number of stones, outcomes, and complications. There was a striking lack of follow-up data, despite a known high recurrence rate. The literature on laparoscopic management was too sparse to analyze.
CONCLUSIONS: This meta-analysis revealed there are not enough high-quality studies to evaluate the ideal strategy for the diagnosis and treatment of CDs. This systematic review emphasizes a) the importance of contrast imaging for CD diagnosis, b) higher success rates but also higher complication rates in PCNL than SWL and FURS and c) the need for standardized reporting of outcomes to include complications, need for further intervention, symptom resolution, stone clearance and CD ablation.

J Endourol. 2018 Jun 15. doi: 10.1089/end.2018.0332. [Epub ahead of print]