Ureteroscopic Management of Symptomatic, Simple Parapelvic Renal Cyst

Abstract

Laparoscopic treatment of parapelvic renal cysts, as a gold standard, is quick and effective. Ureteroscopic unroofing, however, could be used as an alternative technique in selected patients. Two men (aged 56 and 53 years) presented with parapelvic cyst. In the first patient, intravenous urography and CT scan revealed multiple renal cysts with a 6 x 5 cm parapelvic cyst, and the other patient showed a 6.5 x 7.5 cm parapelvic cyst, both with hydronephrosis. There were no solid tissues in the cysts. Semirigid ureteroscopy was performed and the parapelvic cyst was unroofed and marsupialized to the adjacent collecting system. Retrograde pyelography was performed within 5 hours of the procedure, and the ureteral catheter was removed. We evaluated our patients at 2 weeks and 3 months postoperatively. We had no intraoperative or postoperative complications. Operative times were 35 and 30 minutes in patients 1 and 2, respectively. Retrograde pyelography showed contrast media filling the parapelvic cyst and the collecting system without extravasation. The first patient's flank pain was partly relieved. In the other patient, hypertension decreased noticeably (preoperational: 160/95 mm Hg, and postoperational 3 months: 135/85 mm Hg) and right flank pain totally disappeared. Intravenous pyelography and CT images showed objective improvement in hydronephrotic changes, with no evidence of symptomatic and radiographic recurrences. Ureteroscopic treatment is feasible and safe in selected patients with simple parapelvic renal cysts; however, further studies with longer follow-up periods are essential to document its durability.