Percutaneous Approach in the Treatment of Renal Cyst with Ipsilateral Renal Stones

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is widely performed for the treatment of renal stones. It has been reported that the percutaneous approach can be used in the treatment of parapelvic cyst. As for the patients with renal cyst and ipsilateral renal stones, laparoscopic renal cyst decortication and PCNL are usually carried out for the cyst and stones, respectively. In this video, we show a percutaneous approach in the treatment of renal cyst with ipsilateral renal stones during a procedure. This technique is performed for the treatment of dorsal renal cyst with ipsilateral renal stones, The diameter of the cyst is >5 cm and the stones cause hydronephrosis. Materials and Methods: Three cases of renal cyst with ipsilateral renal stones were performed by the percutaneous approach, which included the procedures of cyst decortication and PCNL. The patient was placed in a lithotomy position under a general anesthesia, a 5F ureteral catheter was inserted into the target renal pelvis under the ureteroscope. Then, the patient was turned into a prone position. Under the guidance of ultrasound, an 18-gauge puncture needle was penetrated into the renal cyst, a zebra guidewire was inserted into the cyst followed by dilatation of the percutaneous access with 20F peel-away sheath. Both the ureteroscope and peel-away sheath retreated to the layer between the fibrous capsule and the adipose capsule of the kidney. With the effect of perfusion water, an isolating layer of water was formed between the fibrous capsule and the adipose capsule of the kidney. It was clear to determine the boundary between the exterior cyst wall and the renal parenchyma after the exterior cyst wall was dissociated by using the ureteroscope and peel-away sheath. After that, the ureteroscopic grasper forceps were inserted through the peel-away sheath to grasp the renal cyst wall, and the exterior cyst wall was cut off by holmium laser. In the end, the margin of the exterior cyst wall was ~1 cm distant from the renal parenchyma. After cyst decortication, another access for PCNL was established and stones were fragmented with a holmium laser through the ureteroscope. The big fragments of the stone were removed using a forceps, while small fragments of the stone were pushed out using the pulsed perfusion pump. Results: The procedure was carried out effectively in all three patients, and no intra- or postoperative complications were noted. Computed tomography showed that there was no cyst or stone in the kidney 1 week after the operation, only one case of a small cyst (of which the diameter was <2 cm) remained 6 months after the operation. Conclusions: The percutaneous approach is safe, effective, and reliable for the treatment of renal cyst with ipsilateral renal stones, especially for the dorsal renal cyst with ipsilateral renal stones that may be carried out during a procedure and implemented in the clinical setting. No competing financial interests exist. Runtime of video: 6 mins 4 secs