Percutaneous Endocystolysis, a Safe and Minimally Invasive Treatment for Renal Cysts: A 13-Year Experience

Abstract

Renal cysts are the most common form of renal mass with a prevalence of 35% in people older than 50 years. Several techniques are used to manage symptomatics cysts, from sclerotherapy to open surgery. We present a safe and minimally invasive therapeutic alternative: Percutaneous endocystolysis (PE). Between 1995 and 2008, 32 patients were treated for large symptomatic Bosniak type I and II renal cysts with the PE technique. Percutaneous access was obtained by direct puncture guided by fluoroscopy or ultrasonography, percutaneous dilation, and placement of a 28F Amplatz sheath; then a 26F resectoscope with a rollerball electrode was introduced into the interior of the cyst and the whole internal surface was inspected and cauterized. After cauterization, a 20F Foley catheter was placed inside the cyst. Patients were discharged the next day, and the catheter was removed in the outpatient facility after 7 to 10 postoperative days. The variables of age, cyst volume, operative time, and length of hospital stay were statistically analyzed using the Pearson linear correlation coefficient. Clinical follow-up ranged from 4 to 162 months (mean 76 mos). Percutaneous access to the cyst was obtained by blind puncture in 7 (21.8%) patients, aided by fluoroscopy in 12 (37.5%) patients, and guided by ultrasonography in 13 (40.7%) patients. Clinical improvement was observed in all patients with a success rate of 100%. The length of hospital stay was 21.7 ± 8.5 hours (range 9-48 h). The operative time was 41.8 ± 19.7 minutes (range 12-94 min). There was a low complication rate associated with the transparenchymatous PE procedure. PE is a safe, minimally invasive, and effective technique for the management of large symptomatic renal cysts and is associated with high success rates and low complication rates in long-term follow-up.