V5-13 A NEW APPROACH FOR THIRD LEVEL DIAGNOSIS FOR COMPLEX RENAL CYSTS

Abstract

You have accessJournal of UrologyRenal Oncology/Robotics1 Apr 2014V5-13 A NEW APPROACH FOR THIRD LEVEL DIAGNOSIS FOR COMPLEX RENAL CYSTS Francesco Porpiglia, Marco Cossu, Massimiliano Poggio, Riccardo Bertolo, Nicoletta Serra, Diletta Garrou, Daniele Amparore, Enrico Checcucci, Roberta Aimar, and Cristian Fiori Francesco PorpigliaFrancesco Porpiglia More articles by this author , Marco CossuMarco Cossu More articles by this author , Massimiliano PoggioMassimiliano Poggio More articles by this author , Riccardo BertoloRiccardo Bertolo More articles by this author , Nicoletta SerraNicoletta Serra More articles by this author , Diletta GarrouDiletta Garrou More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Roberta AimarRoberta Aimar More articles by this author , and Cristian FioriCristian Fiori More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1716AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Complex renal cysts may cause diagnostic matters, since it is often difficult to exclude malignancies. The Bosniak classification of renal cysts is a well-established worldwide method based on CT findings to categorize cystic renal masses but, expecially for cysts classified as Bosniak II and III, some studies highlight a not trascurable frequency of false negative and positive malignancy diagnoses. To overcome this limitation, cysts puncture for evacuation and core biopsies can be used trying to make a diagnosis but a recent Literature review emphasized the higher risk of biopsy failure, false-negative results, and potential spreading of tumour cells resulting from cystic rupture: these aspects lead many urologists to limit the indications of core biopsies. Trying to give an answer in this field we present a new “third-line” diagnostic tool for complex cysts renal tumors. Methods We present the case of a male patient, 35 years old, BMI 22. After an incidental US detection of a large cyst a the lower pole of the left kidney with exophytic growth pattern, the diagnosis was confirmed by an imaging workup consisting of contrast-enhanced abdominal CT-scan and abdominal MRI. In addition, they highlighted an involvement of renal pelvis and lower calyceal system. The MRI dynamic study showed the presence of 2 small intraluminal prominence. To specify the diagnosis in this complex cysts renal tumor, we proceeded as follows: patient was placed in a Galdakao-modified supine Valdivia position. Under US guidance a puncture of the cyst was performed by 16 G needle, named MICROPERC®, endowed by a dedicated sheet (4.85 F). The needle was then removed, the 4.85 F sheath was left in place. 20 mL of citrine fluid were suctioned and sent for extemporary cytological examination with unconclusive result. An adapter with “Luer-lock” junction was connected to the needle. After its setup, the optical fiber was inserted through the sheath and moved forward to the cyst. Endoscopic exploration of the cyst was performed and finally, two intraluminal prominence were identified. We therefore decided to perform a laparoscopic radical nephrectomy. Results Operative time was 165 minutes. No perioperative complications occurred. Patient was discharged at third postoperative day. At histopahological examination a papillary malignant renal tumor was found. Conclusions The percutaneous needlescopic exploration of renal cysts according the described technique offers a new perspective in the diagnostic assessment of complex renal cysts. This approach could be used as a third-line diagnostic tool when either imaging or biopsy were inconclusive. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e620 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Francesco Porpiglia More articles by this author Marco Cossu More articles by this author Massimiliano Poggio More articles by this author Riccardo Bertolo More articles by this author Nicoletta Serra More articles by this author Diletta Garrou More articles by this author Daniele Amparore More articles by this author Enrico Checcucci More articles by this author Roberta Aimar More articles by this author Cristian Fiori More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...