Percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in selected patients: killing two birds with one stone?

Abstract

To assess the safety, feasibility, and efficacy of percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in the management of a renal cyst with ipsilateral calculi in selected patients. Between July 2010 and August 2013, 16 patients (11 men and 5 women; mean age, 51 years) with a solitary posterior or parapelvic renal cyst and ipsilateral calculi underwent percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in our center. Mean cyst size was 6.3 cm (range, 4.2-11.8 cm). Mean stone surface area was 5.8 cm(2) (range, 1.8-12.1 cm(2)). By preoperative computed tomography planning and interoperative ultrasound guidance, the optimal puncture route was selected carefully to marsupialize the cyst and approach the target calyx. The cyst was marsupialized into the collecting system at the dilation process. Subsequently, percutaneous nephrolithotomy was performed in a standard fashion. The mean operative time was 68 minutes (range, 47-93 minutes), and the mean hospital stay was 4 days (range, 3-7 days). A nephrostomy tube and a double-J stent were placed for a prolonged period to ensure the channel remained opened. Nearly complete cyst regression and calculi clearance confirmed by postoperative imaging was achieved in all patients. No intraoperative or postoperative complications in Clavien grading score ≥ 2 were noted during a mean follow-up of 21 months (range, 8-25 months). In selected patients with a posterior or parapelvic renal cyst and ipsilateral calculi, the percutaneous technique is a safe and effective option through intermediate follow-up.