The Novel Use of Flexible Ureteroscopy and Holmium: YAG Laser in the Management of Parapelvic Renal Cysts

Abstract

Kidneys are very common sites of cysts in the human body, prevalence of renal cysts was estimated to be about 10% in the general population and the incidence increases with age. Parapelvic and peripelvic cysts grow near renal collecting system; these types of cysts are most likely to be symptomatic. There are a number of reports describing successful laser incision drainage of parapelvic cysts into the renal pelvis using flexible ureteroscopy transurethrally. This review focuses on specific aspects of clinical usage and novelty of flexible ureteroscopy and holmium laser in the management of parapelvic cysts. A systematic review of articles written in the English language on the subject appearing in the medical journals was conducted using Medline database. Cysts that grow near and inside renal pelvis almost always present with symptoms and require treatment intervention. The intervention is guided by the size of the cyst and severity of the symptoms. Flexible ureteroscopic holmium laser marsupialization of parapelvic cysts is less morbid and complications when compared to laparoscopic decortication approach which is technically very challenging due to the locations of these types of cysts. Retrograde marsupialization of parapelvic cysts is a novel technique which does not need any skin incision at all, thus improving cosmesis after surgery. This approach is a pure and of classical natural orifice transluminal endoscopic surgery (NOTES), it reduces morbidity, mortality, and surgical complications.