Ureteroscopic laser incision and drainage of an obstructive parapelvic renal cyst: A case study

Abstract

Abstract Objective and background To describe the steps for ureteroscopic laser incision and drainage of an obstructive parapelvic renal cyst. Renal cysts are benign lesions of the kidney which represent more than 70% of asymptomatic renal masses. Majority of simple or minimally complex cysts do not require further follow-up or therapy upon diagnosis. However, in 2 - 4% of the cases, these simple renal cysts can become symptomatic due to enlargement, development of complications such as haemorrhage, infection, rupture or obstructive uropathy. Various interventions have been described which include open surgery, percutaneous aspiration with or without sclerosing agent, laparoscopic decortication, percutaneous ablation, retrograde endoscopic marsupialization and even robotic-assisted laparoscopic decortication. Patient and Method 67-year-old man had an asymptomatic right renal cyst which progressively enlarged to the extent that it caused obstructive uropathy. Computed tomography (CT) scan showed an obstructive 9 cm right parapelvic renal cyst. We performed laser incision and drainage of the cyst with semi-rigid ureteroscope under general anaesthesia. The cyst was identified endoscopically and confirmed with fluoroscopy prior to incision with holmium laser using 200-um fibre. Results The cyst was drained successfully and two double J ureteric stents were placed into upper pole calyx and cyst cavity, to ensure adequate drainage and reduce reflux into the cyst cavity. The operative time was 30 minutes. There was no complication and the patient is discharged on postoperative day two. Postoperative CT scans showed complete resolution of the hydronephrosis with no recurrence. Conclusion Overall, in the reported literatures, the symptomatic success rate is 83 – 100% and the average radiologic success rate is 90%. Ureteroscopic laser incision and drainage of obstructive or symptomatic benign renal cyst in selected cases offers the patient the advantages of endoscopic surgery with shorter hospital stay, rapid recovery, minimal trauma and excellent outcome.