Chronic Flank Pain Research Articles

The thin line that made the difference: a case report on a Bosniak IIF renal cystic mass treated with cyst decortication

BackgroundAmong all benign kidney lesions, renal cysts are the most common type. In the proposed update of 2019, the Bosniak classification of cystic renal masses is used to classify renal masses according to their likelihood of malignancy, both on computed tomography (CT) and on magnetic resonance imaging (MRI).Case presentationA middle-aged Caucasian male presented to our department with chronic right flank pain. Imaging studies revealed a right renal Bosniak IIF cyst, later complicated by traumatic haemorrhage. The patient consequently underwent cyst decortication for symptom relief. Biopsy results from samples taken during the laparoscopic operation revealed ISUP grade 1 cystic clear cell carcinoma.ConclusionThe treatment of Bosniak IIF cysts has long been a matter of debate. As a result of scarcity of data on the probability of malignancy in MRI using the new classification, such cysts should be carefully scrutinised and staged before choosing a treatment option. Retroperitoneal seeding should always be considered in interventions involving an incomplete resection margin or cyst drainage.

Acute on Chronic Right Flank Pain

This case challenge presents an elderly female living in a long-term care facility who has chronic right flank pain associated with chronic nephrolithiasis and frequent urinary tract infections. Acute on chronic flank pain can be a symptom of gastrointestinal or urologic issues, which further complicates treatment. Acute flank pain requires timely access to diagnostic equipment to ensure the most accurate and timely diagnosis.

Detection of Mycobacterium tuberculosis in urine by GeneXpert MTB/RIF as a useful diagnostic tool in urinary tuberculosis

Background: Early and accurate diagnosis of urinary tuberculosis (UTB) is difficult as current diagnostic methods are lack of specificity (biochemical levels), lack of sensitivity (acid-fast bacilli stains), and time-consuming (TB culture). GeneXpert MTB/RIF has been endorsed by WHO and Indonesia Ministry of Health particularly for the sputum, and also gastric and lymph fluid samples. Given the limited data on the utility of GeneXpert MTB/RIF for urine samples, the recommendations do not apply to these samples. Case Description: A 38 y old woman was referred to the tertiary care hospital with suspected nephrolithiasis. She had a history of mild to moderate chronic flank pain and found to have left hydronephrosis on renal ultrasound. Ureteroscopy showed diffuse whitish necrosis of ureteral mucosa and ureteropelvic junction which was suspicious of tuberculous ureteritis. The acid-fast bacilli (AFB) smears gave negative result. Early morning sample was sent for GeneXpert MTB/RIF and the result was MTB detected with rifampin resistance not detected. The patient was managed with 6 m antituberculosis treatment according to the Ministry of Health regulation. Discussion: UTB was diagnosed using the urine AFB test, urine TB culture test and GeneXpert. Although the urine AFB test is simple, economical, and rapid, it has low sensitivity and specificity. TB culture has higher specificity compared AFB test but requires eight ws before the results are obtained. GeneXpert MTB/RIF, a real-time PCR, is a sensitive and specific test with 131 cfu/mL limit of detection that allows for early detection of TB. AFBs are intermittently shed in urine and the sensitivity of GeneXpert can be improved by using early morning urine for extended periods ranging from three to five days. Conclusion: GeneXpert MTB/RIF performed on urine samples is useful and can be recommended for rapid and reliable diagnosis of UTB in clinical practice esepecially in area with high TB burden. The diagnostic accuracy of urine GeneXpert MTB/RIF should be characterised further via prospective studies.

Crossed complete fused left to right renal ectopia with solitary left ureter: A rare \u2018Case Report\u2019

BackgroundCrossed fused renal ectopia is a rare congenital anomaly where both the kidneys are fused and situated on one side and drain bilaterally into the urinary bladder. Rarely crossed fused ectopia can present with a single ureter draining ipsilaterally into the bladder, but here we are presenting for the first time a rare case of right crossed fused ectopia, where a solitary ureter crosses midline and drains contralaterally into the bladder.Case presentationA 19-year-old adolescent male patient presented with intermittent chronic right flank pain for 3 months. General physical and per abdominal examinations were normal. Computerized tomography (CT) urography showed right side crossed fused ectopic kidneys with a solitary ureter draining both the kidneys and opening into the left side of the urinary bladder. The patient was managed conservatively and is on regular follow-up.ConclusionCrossed complete renal fused ectopia with solitary contralateral ureteral is a rare case. Individualized case-based management is needed depending upon the symptoms, associated anomalies, and pathology. Reporting of all rare congenital cases will help in the future understanding and management of these conditions.

Pain Management Techniques for Loin Pain Hematuria Syndrome Case Report

Background: Loin pain hematuria syndrome (LPHS) is a rare syndrome presenting with chronic unilateral or bilateral flank pain and gross or microscopic hematuria. Case Report: We present a case of LPHS in a male with past medical history of atrial fibrillation, Barrett’s esophagus, and loin pain hematuria syndrome who initially presented to our medical facility with gross hematuria, intractable left flank pain, and non-bloody emesis. Our case exemplifies the challenge in managing patients with LPHS. Conclusion: Without a definitive mechanism for LPHS, current treatment focuses on symptom management. Analgesics (non-opioid and opioid) may be used orally or intravenous depending on the presence of concomitant nausea and vomiting. For patients at risk of opioid dependence, targeting afferent pain fibers originating from the kidneys and ureters has proven a successful analgesic strategy. Surgical options for renal denervation include: endovascular radiofrequency ablation, laparoscopic renal denervation, and renal auto transplant. Treatment options for this disease process include intra-ureteric bupivacaine, renal denervation, and possible spinal cord stimulation. Key words: Flank pain, loin pain hematuria syndrome, renal denervation, spinal cord stimulation

Immunoglobulin G4-Related Bilateral Kidney Disease

Immunoglobulin G4-related disease (IgG4-RD) is uncommon and is characterized by dense tissue infiltration of IgG4-positive plasma cells or mass-like sclerosing lesions. In addition, it can involve any anatomic site, which has frequently elevated serum IgG4 concentrations. Japanese gastroenterologists are the ones who first discussed the concept of IgG4-RD; they first introduced the term IgG4-related kidney disease (IgG4-RKD), which refers to the involvement of the kidney and its surrounding tissues. Common urologic indicators of IgG4-RKD typically include subacute pain, on the detection of a tumor-like mass or enlargement, with or without tubulointerstitial nephritis. Conventional imaging computed tomography and magnetic resonance imaging are of limited usefulness in determining IgG4-RKD. The gold-standard for the diagnosis of IgG4-RD is the identification of typical histopathological features of dense lymphoplasmacytic infiltration, storiform fibrosis (an irregular cartwheel like fibrotic pattern), and obliterative phlebitis; these are the three hallmarks of IgG4-RD. The current report discusses a case of IgG4-RKD, who came into our hospital with chronic flank pain.

Chronic renal pain: An approach to investigation and management.

A comprehensive attempt should be made to identify a cause for the chronic flank pain experienced by the patient. In many cases, resolution of the underlying pathology results in improvement of the pain, but for others, pharmacologic, ancillary surgical procedures and psychological support are required to reduce the impact of pain on the patient’s quality of life.

Laser Papillotomy for Chronic Flank Pain – A Reassessment of Efficacy in the Era of Automated Opioid Prescription Monitoring

ObjectiveTo determine if laser papillotomy for patients with chronic flank pain decreased narcotic pain medication usage post-surgery. Specifically the introduction of state-specific automated prescription reporting systems offers the opportunity for a more objective longitudinal assessment of outcomes in patients who often utilize multiple providers for pain management. Materials and MethodsPatients who underwent laser papillotomy for chronic flank pain at a single institution between January 2013 and January 2017 were identified. Narcotic prescription refill information for the 12 months prior to the surgery and the 12 months after was obtained through the Ohio Automated Rx Reporting System (OARRS) and the Pennsylvania Prescription Drug Monitoring Program (PA PDMP). Results10 patients underwent laser papillotomy for chronic flank pain. Preoperative outpatient narcotic prescriptions filled ranged from 0 to 23 prescriptions, with a mean of 10.5 separate prescriptions per patient. Postoperatively, 8/10 (80%) of patients were considered failures. Six patients had multiple narcotic pain medication refills, with the mean number of pills filled recorded as 993.3 in the 12 months post-surgery. One patient became a heroin addict postoperatively and another required ongoing care in the chronic pain clinic. ConclusionsLaser papillotomy for chronic flank pain has a high failure rate, especially in patients who are on narcotic pain medication preoperatively. In the era of automated opioid prescription monitoring, urologists should use such information to make surgical decisions and properly counsel patients.

Unilateral Renal Primitive Neuroectodermal Tumor (PNET)

Introduction: Primitive neuroectodermal tumor (PNET) of kidney is a rare clinical condition. We report a young girl with PNET of kidney. Case Presentation: A 14-year-old female presented with chronic flank pain. Imaging studies revealed a huge renal mass with left renal vein thrombosis. Histopathological findings were consistent with PNET, which was later confirmed by immunohistochemistry and she received adjuvant chemotherapy. Conclusions: PNET is a rare clinical condition in urology and it should be considered in young patients with a renal mass, especially when it is huge. Treatment plan includes radical nephrectomy along with neoadjuvant chemotherapy.

Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain

Background and aimsChronic abdominal pain may occasionally be due to terminal endings of intercostal nerves (ACNES, abdominal cutaneous nerve entrapment syndrome) that are entrapped in the abdominal wall. Spontaneous neuropathic flank pain may also be caused by involvement of branches of these intercostal nerves. Aim is to describe a series of patients with flank pain due to nerve entrapment and to increase awareness for an unknown condition coined Lateral Cutaneous Nerve Entrapment Syndrome (LACNES). MethodsPatients possibly having LACNES (constant area of flank tenderness, small point of maximal pain with neuropathic characteristics, locoregional altered skin sensation) presenting between January 2007 and May 2016 received a diagnostic 5–10mL 1% lidocaine injection. Pain levels were recorded using a numerical rating scale (0, no pain to 10, worst possible). A >50% pain reduction was defined as success. Long term effect of injections and alternative therapies were determined using a satisfaction scale (1, very satisfied, no pain – 5, pain worse). Results30 patients (21 women, median age 52, range 13–78) were diagnosed with LACNES. Pain following one injection dropped from 6.9±1.4 to 2.4±1.9 (mean, p<0.001) leading to an 83% immediate success rate. Repeated injection therapy was successful in 16 (pain free n=7, pain acceptable, n=9; median 42 months follow-up). The remaining 14 patients received (minimally invasive) surgery (n=5) or other treatments (medication, manual therapy or pulsed radiofrequency, n=9). Overall treatment satisfaction (scale 1 or 2) was attained in 79%. Conclusions and implicationsLACNES should be considered in patients with chronic flank pain. Injection therapy is long term effective in more than half of the population.

Intrinsic ureteral endometriosis as a cause of unilateral obstructive uropathy.

Endometriosis is a common gynecological condition, but involvement of the urinary tract is rare. Ureteral endometriosis can present in a nonspecific fashion, and may mimic ureteral malignancy. This case report describes a 44-year-old woman who initially presented with chronic flank pain and was found to have left-sided renal dysfunction and a distal left ureteric mass. She was eventually diagnosed with ureteral endometriosis after undergoing nephroureterectomy for what was thought to be either a ureteral fibroepithelial polyp or transitional cell carcinoma. Ureteral endometriosis should be considered in the differential diagnosis for a woman presenting with obstructive uropathy in the presence of a ureteric mass.

Robotic Pyeloplasty of a Pelvic Kidney with Ureteropelvic Junction Obstruction

Abstract Introduction: The incidence of an ectopic pelvic kidney has been approximated at between 1 in 2200 and 1 in 3000. Often times, these kidneys are malrotated and may be associated with anomalous blood supply. Ureteropelvic junction obstruction (UPJO) has been reported to occur in 22% to 37% of ectopic kidneys and classically requires an open surgical approach for repair. In this video, we present a unique case of a patient with UPJO of an ectopic pelvic kidney, which was managed with robotic pyeloplasty. Materials and Methods: Our patient is a 46-year-old male who presented for evaluation of chronic suprapubic and right flank pain. A computerized tomography (CT) study of the abdomen and pelvis was notable for an ectopic right-sided kidney located in the true pelvis exhibiting significant hydronephrosis compatible with UPJO. A renal scan supported the diagnosis and was notable for split renal function of 20% on the right and 80% on the left. The patient was offered a robotic pyeloplasty as a definit...

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation. A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher. A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive. Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.

Endoscopic Management of Submucosal Renal Stones

Introduction: The prevalence of kidney stones in the United States is estimated at 5%–10% and increasing. Stone disease can lead to pain, renal obstruction, and renal injury. Papillary calcifications may also cause chronic flank pain, which can be relieved in up to 85% of cases, with durable outcomes in 60% of cases, by ureteroscopic laser papillotomy. In this study, we aim to describe the endoscopic technique to treat submucosal renal stones. Patients and Methods: A 57-year-old man presented with intermittent left flank pain. Otherwise healthy, his only medical issue has been nephrolithiasis. One previous left ureteroscopy documented the presence of submucosal stones. The patient was first evaluated with a noncontrast computed tomography. Imaging revealed multiple calcifications in the upper, middle, and lower pole, with the largest being 1.0 cm, located on the lower pole. Blood work showed normal serum creatinine and electrolytes, and 24-hour urine collections had high urinary sodium, calcium, oxalate, and uric acid. After an initial consultation, a decision was made to treat the stone burden through flexible ureteroscopy. Results: Several visible papillary calcifications were fragmented with a 200-μm laser fiber set at 800 Hz and 0.8 J until they were released from the papilla. Once free, stones were basketed and removed. When no more papillary calcifications or submucosal stones were identified through endoscopy, fluoroscopy was used to find which renal papilla contained submucosal stones and the procedure was repeated to treat all radiopaque stones. At the end of the surgery, a Double-J stent was placed. The operative time was 2 hours, blood loss was minimal, and there were no intra/postoperative complications. The stent was removed after 1 week and the patient remained asymptomatic at a 2-month follow-up. Stone composition analysis revealed pure calcium stone. Conclusion: Endoscopic management of submucosal renal stones is feasible and safe, it may improve stone-related symptoms, and can provide a stone-free status. No competing financial interests exist. Runtime of video: 6 mins 35 secs

Effect of percutaneous renal denervation on blood pressure level and sympathetic activity in a patient with polycystic kidney disease

Sirs: The underlying mechanisms for the rise in blood pressure in individuals with autosomal dominant polycystic kidney disease (ADPKD) are complex, and experimental and clinical data support the concept that sympathetic hyperactivity may contribute to the pathogenesis of hypertension in ADPKD [1, 2]. More recently, a catheter-based percutaneous aimed at ablating both efferent and afferent renal nerve fibres has been introduced into clinical medicine and has been demonstrated to safely and effectively reduce blood pressure in patients with treatment resistant hypertension and normal renal function [3–6]. However, to our knowledge there is only one report of Shetty et al. [7] who observed after renal denervation resolution of chronic pain related to renal cysts and delayed fall in blood pressure in patient with ADPKD and resistant to treatment hypertension. No data on reduction of sympathetic activity has been shown. A 26-year-old male with polycystic kidney disease was referred to the Department of Hypertension by the end of 2012 for the consideration of percutaneous renal denervation due to resistant hypertension. At the age of 20, the patient was first diagnosed with hypertension and also with ADPKD. A family history of polycystic kidney disease was present in the mother and in addition to in a sister. At the time of referral, the patient had an office blood pressure of 162/77 mmHg and an average day-time ambulatory blood pressure of 138/73 mmHg despite four antihypertensive medications comprising valsartan 160 mg od, amlodipine 10 mg od, nebivolol 2.5 mg od, and hydrochlorothiazide 25 mg od. No history of cardiovascular disease or diabetes was reported, the patient has never smoked. The patient has normal renal function at baseline with a serum creatinine of 74 μmol/L and estimated glomerular filtration rate by MDRD formula of >60 mL/min/1.73 m2. The patient was not troubled by chronic flank pain. On Doppler duplex examination renal arteries were normal, renal resistive index values were 0.61 and 0.66 in the right and left kidney, respectively. Abdominal ultrasound showed enlarged size of right (145 mm) and left (180 mm) kidney with multiple simple renal cortical cysts with a maximum diameter of 3 cm. Hepatic cysts were not present. Abdominal MRI showed bilateral simple appearing renal cysts in the upper and lower poles. Microneurography was performed before and 3 months after the renal denervation. Muscle sympathetic-nerve activity (MSNA) signals were recorded by an electrode placed into the peroneal nerve at the popliteal fossa, posterior to the fibular head and the reference electrode was placed subcutaneously 2–3 cm from the recording electrode. Due to his uncontrollable blood pressure percutaneous renal sympathetic denervation using the Symplicity Catheter® system was performed as described previously [5], with five ablations in left and six in right renal artery (Fig. 1). The patient was discharged the following day on his pre-ablation antihypertensive regimen. The only complication of the procedure was transient stenosis of both arteries resulting from artery spasm and edema. Fig. 1 Symplicity Catheter® in the left renal artery. It was possible to perform five ablations in the left renal artery The patient was reviewed at 1 and 3 months post renal sympathetic denervation. At 1 month follow up he had improvement in his systolic blood pressure with an office reading of 129/60 mmHg and at 3 month follow up his blood pressure had dropped to 120/74 mmHg. A 24-h ambulatory blood pressure monitoring at 1 and 3 months confirmed blood pressure control with a mean day-time blood pressure of 131/68 and 128/65 mmHg, respectively. His renal function remained unchanged at 1 and 3 months. Microneurography at 3 months showed a reduction in MSNA (Fig. 2), as assessed in the peroneal nerve. Fig. 2 Reduction in blood pressure and muscle sympathetic-nerve activity (MSNA), as assessed in the peroneal nerve on microneurography 3 months after bilateral renal-nerves ablation Our case report confirms the safety and effectiveness of a catheter-based renal denervation approach for the treatment of resistant hypertension in patients with ADPKD. While a single case has its obvious limitations, the fall in blood pressure after the procedure was accompanied by the decrease in the sympathetic activity being likely mediated via ablations of different fibres responsible. However, it should be mentioned that MSNA may not give information specifically about renal sympathetic activity [8]. In our case, larger reductions in office than in ambulatory blood pressure were noticed. However, these changes were of comparable magnitude as reported in the prospective studies [5, 9, 10]. In these groups, also the discrepancy between reduction in office and ambulatory blood pressure was also noted, but is should be stressed that observed reductions provide an equivalent reduction in cardiovascular events [5, 8, 11]. Confirmation of substantial BP lowering via catheter-based renal afferent denervation in patients with ADPKD in future studies may provide a valuable and safe alternative for the management of this difficult clinical condition.

A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves

Chronic abdominal and flank pain can be multifactorial and difficult to treat. Loin pain hematuria syndrome (LPHS) is a rare clinical cause of chronic abdominal and flank pain and is a diagnosis of exclusion with limited treatment options, ranging from medications to renal autotransplantation or even nephrectomy in resistant cases. A 50-year-old man with a history of recurrent nephrolithiasis secondary to hypercalcemia presented to the pain clinic with bilateral flank pain. After failed conservative medical management, the decision was made to proceed to interventional modalities. He responded for a short duration to a splanchnic nerve block and subsequently had a longer analgesic response to pulsed radiofrequency (PRF) ablation to the splanchnic nerves. LPHS is a difficult clinical scenario to diagnose and treat. Conservative options are often unsuccessful, but the more extreme interventions such as renal autotransplantation and nephrectomies are invasive and not always effective. In this case report, we describe the novel use of PRF to the splanchnic nerves as an alternative treatment modality for patients with LPHS.Although the exact mechanism of action of PRF on nerve tissue is unclear, its indication in pain management requires further research and discussion. Our patient experienced substantial and sustained relief of his flank pain. PRF may be a viable option for patients with LPHS.

Multilocular cystic nephroma: A case report and review of the literature

Multilocular cystic nephroma is a rare cystic renal tumor, which is benign and has an excellent prognosis. However, preoperative diagnosis is challenging and is made exclusively by pathological findings. We reported a 41-year-old woman with chronic flank pain, and abdominal computed tomography revealed a multiloculated renal cystic tumor. The possibility of a cystic variant of renal cell carcinoma could not be excluded. Laparoscopic radical nephrectomy was performed, and diagnosis of multilocular cystic nephroma was made. In this report, we describe the clinical presentation, radiological finding, and histopathology of this case.

Secondary Hypertension Caused by Massive Renal Lymphangiomatosis

Renal lymphangiomatosis is a rare disease characterized by lymphatic vessel proliferation. We present a case of an adult patient with chronic flank pain, hypertension, and a right kidney mass. The magnetic resonance imaging findings were consistent with unilateral renal lymphangiomatosis. Technetium-99m dimercaptosuccinic acid renal scintilography revealed decreased ipsilateral renal function. From these findings, the patient underwent right nephrectomy, which resulted in complete remission of his hypertension and pain.

Phantom organ pain: a myth or a clinical entity

Phantom organ pain syndrome occurs presumably due to injury to the visceral sensory nerves innervating the missing organ. The pain has been attributed to deafferentation due to surgical trauma to the incision site, to deep somatic nerves, to mononeuropathy, or to the possibility of phantom organ pain syndrome. We present a case of a man with chronic left flank pain and pyelonephritis despite ongoing therapy with antibiotics and hydrocodone. Ultimately, a left-sided nephrectomy was performed which resolved his chronic infection but did not minimize his chronic flank pain. Postsurgical imaging included a negative MRI, CT, and ultrasound of his abdomen and pelvis. To determine an optimal treatment plan for our case patient, a literature search for "phantom organ," "phantom pain," and "phantom limb" was undertaken. The following medical databases were used: PubMed, Cochrane Library, MD Consult, Ovid, Google and Google Scholar, Medscape, and UpToDate. Over 100 articles written in English were reviewed, and a total of 36 articles were determined to be clinically relevant to our patient. Only 3 of the 36 aforementioned articles discussed phantom organ pain directly, but no specific treatment for phantom organ pain was described. Multiple treatment options for phantom pain in general were discussed in the reviewed articles. Pharmacologic treatment agents included NSAIDs, narcotics, NMDA antagonists, GABA analogs, anticonvulsants, antidepressants, and muscle relaxants. Interventional treatments included nerve blocks, neurolysis, sympathectomy, spinal cord stimulators, deep brain stimulators, TENS units, and even cortical brain resection. Other significant treatments included rehabilitation and physical therapy, mirror therapy, electromyographic and thermal biofeedback, acupuncture, psychological treatments, and hypnosis. Our case patient was started on low-dose gabapentin and currently very well controlled without narcotics on Gabapentin 600 mg TID and supportive psychotherapy. More research in the field of phantom organ and phantom limb pain is needed to treat this complex disease process.

Percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts: A single-centre experience in China

Objective.The aim of this study was to report the authors' experience with percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts. Material and methods. Thirty-one patients (16 male and 15 female, with a mean age of 49 years) with a peripelvic renal cyst associated with chronic flank or lumbar pain or urinary infection were selected for percutaneous intrarenal marsupialization with a 2 μm laser in the authors' centre from January 2005 to December 2010. Cyst size ranged from 4.5 to 10.5 (mean 6.0) cm. The cysts were punctured by a percutaneous technique guided by ultrasonography, a 20.8 F nephroscope was introduced and the whole internal surface of the cyst was inspected. Methylene blue was injected through the ureteral catheter to help identify the collecting system. A 1.5–4 cm incision was made at the avascular area of the cystic wall by the 2 μm laser to achieve intrarenal marsupialization of the cyst into the renal collecting system. One or two 6 F double-J stents were placed with the proximal end in the cyst for 2–3 months. Results.The mean operation time was 50 (25–120) min. No serious complications such as massive bleeding, urine leak or infected haematoma occurred. The patients were followed up for a mean of 12 (range 3–36) months. All patients were relieved of their symptoms. Eighteen cysts disappeared after surgery, while 13 cysts reduced in size by over one-third and communicated with the renal collecting system. No enlargement of cysts was observed. Conclusions.Percutaneous intrarenal marsupialization with a 2 μm laser is an effective and safe procedure and may offer a minimally invasive alternative for the management of symptomatic peripelvic renal cysts.