Percutaneous ureteroscopy laser unroofing-a minimally invasive approach for renal cyst treatment

Jia Hu,Jun Yang,Xiao Yu,Najib Isse Dirie,Yuchao Lu,Ding Xia,Shaogang Wang

doi:10.1038/s41598-017-14605-4

Jia Hu, Jun Yang + Show 5 more

Open Access

https://doi.org/10.1038/s41598-017-14605-4

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Abstract

Most simple renal cysts rarely require therapy. When it grows to such a large size, regardless of the presence of symptomatology, surgical intervention is required. In this study, we explored a new approach called percutaneous ureteroscopy laser unroofing for treatment renal cysts and evaluated its safety and efficacy. 71 simple renal cyst patients with surgical indications were enrolled, including 6 patients with a peripelvic cyst and 5 patients coexisting ipsilateral calculi. Under ultrasound guidance, an eighteen-gauge needle was placed inside the cyst cavity, and a guidewire was introduced followed by sequential dilation up to 28 F. The extra-parenchymal portion of cyst wall was dissociated and incised using either a Thulium or Holmium laser, and a pathological examination was performed. Renal calculi were treated simultaneously. For peripelvic cyst patients, one end of a double-J stent was inserted into the cyst cavity to prevent auto-closure. Mean of 11.7 months follow-up, the results showed that the cyst was completely resolved in 53 patients, its size was reduced to less than 50% in 15 patients, and treatment failed in only 3 anterior cyst patients, suggesting that percutaneous ureteroscopy laser unroofing is an effective and less invasive alternative for treatment of renal cysts in selected patients.

Highlights

Renal cysts are simple benign lesions with an unknown etiology that are either inherited or acquired
These include cyst aspiration[5], surgical resection[6,7], and sclerotherapy with a variety of different agents[8,9]. None of these approaches appear to be better than the others described, aspiration and sclerotherapy are associated with a higher incidence of cyst recurrence, fever, and ureteropelvic junction obstruction regarding the treatment of peripelvic cysts, given their proximity to the renal vessels and collecting system
We have explored a new approach for the treatment of symptomatic renal cystic lesions that merges the merits of both of the abovementioned methods and is referred to as percutaneous ureteroscopy renal cyst laser unroofing

Summary

Introduction

Renal cysts are simple benign lesions with an unknown etiology that are either inherited or acquired. None of these approaches appear to be better than the others described, aspiration and sclerotherapy are associated with a higher incidence of cyst recurrence, fever, and ureteropelvic junction obstruction regarding the treatment of peripelvic cysts, given their proximity to the renal vessels and collecting system These techniques may require multiple treatments to satisfactorily ablate the cystic lesion[5,10]. We have explored a new approach for the treatment of symptomatic renal cystic lesions that merges the merits of both of the abovementioned methods and is referred to as percutaneous ureteroscopy renal cyst laser unroofing This significantly less invasive approach needs only one port, is more comfortable for patients, and requires less expensive anesthesia than a laparoscopic procedure. We sought to assess the efficacy and safety of this procedure in the management of patients with symptomatic renal cysts or cysts complicated with ipsilateral renal calculi

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Conclusion