Management Of Simple Renal Cysts Research Articles

The role of retroperitoneoscopy in the management of simple renal cysts

The role of retroperitoneoscopy in the management of simple renal cysts

Non-conservative management of simple renal cysts in adults: a comprehensive review of literature.

Renal cysts are common findings in nearly 10% of general population. According to Bosniak classification, they are classified into simple and complex renal cysts based on their CT characteristics. The majority of simple renal cysts are asymptomatic and require no intervention. Once they become symptomatic or complicated, a non-conservative management should be considered. This paper is a narrative review of existing manuscripts regarding the non-conservative management of renal cysts. To perform it a search through PubMed was carried out in January 2017. The search was conducted using the following key words: "simple renal cysts," "non-conservative management," "treatment outcomes comparison" etc. EVIDENCE SYNTHESIS: We found 1880 publications that were reviewed by 2 of our authors, and only 46 manuscripts were considered for this review. The most common treatment were investigated and compared to understand the best treatment modality in accordance with patients' and cysts' characteristics. Different treatment modalities are available for the management of simple renal cysts. Surgical exploration is a historical procedure that is no longer used. Simple aspiration without sclerotherapy has high recurrence rate (20-80%), so sclerosants agents are recommended. Ethanol is the most commonly used sclerosing agent with high efficacy up to 97%. Laparoscopy is the gold standard for management in large cysts especially in younger patients. Other techniques are described for parapelvic renal cysts like percutaneous endoscopic ablation and ureteroscopic marsupialization. Different factors affect the treatment decision including natural history of the cyst, presence of symptoms and/or complications and patients' choice. This literature overview shows that ethanol percutaneous sclerotherapy and laparoscopy are the most commonly reported treatment modality for simple renal cysts.

Abstract No. 704 Single-session 99.5% ethanol sclerotherapy for simple renal cysts: comparison of 40- and 120-minute retention techniques

To compare the results of 40- and 120-minute ethanol sclerotherapies which were performed in a single session for the management of simple renal cysts. We retrospectively reviewed 63 renal cysts in 62 patients treated by single-session percutaneous ethanol sclerotherapy. Thirty-two cysts in 31 patients underwent 40-minute sclerotherapy (group A) and 31 cysts in 31 patients underwent 120-minute retention technique (group B). Under ultrasonographic and fluoroscopic guidance, the cystic fluid was completely aspirated and 50% of the aspirated volume replaced with 99.5% ethanol (maximum, 100 mL). Follow-up of the patients were performed with ultrasonography or computed tomography (CT) at 3 months after sclerotherapy. Overall, technical success rates were 100% in both two groups. Eighteen patients (28.6%) were symptomatic (flank pain or discomfort). Indications of the other patients were large cyst (>5cm; 46%) and increment of the diameter on serial studies (25.4%). There was no significant difference between the two groups in terms of age (62.22 vs. 62.48 years), cyst diameter (8.43 vs. 8.14 cm), volume of aspirated fluid (230.06 vs. 250.16 mL), volume of injected ethanol (77.81 vs. 70.48 mL), and percentage of decrement of cyst diameter (58.6 vs. 53.67%) (P>0.05). After the treatment, flank pain or discomfort resolved in 17 (94.4%) of 18 symptomatic patients. One patient complained persistent flank pain, but no significant abnormality was detected on post-procedural CT images. There were no other complications after therapy in two groups. Single-session ethanol sclerotherapy with 40-minute retention technique is an effective and safe method for the treatment of simple renal cysts. It can reduce the procedural time and length of hospital stay, but there is no statistical difference in therapeutic efficacy between 40- and 120-minute therapies.

Symptomatic simple renal cyst managed by laparoscopic unroofing in a child

Simple renal cysts (SRC) in children are uncommon, usually asymptomatic, and discovered incidentally during investigation for other urinary or abdominal symptoms. The management of SRC in children depends on the symptoms and imaging. Patients can be followed by ultrasonography or other imaging or may be decided an intervention. The available procedures for the treatment of symptomatic cysts are percutaneous aspiration with or without sclerotherapy and open or laparoscopic approaches of the lesions. Only a few small series have been published SRC in children, and is not sufficient data available regarding laparoscopic approach. In this case report, we present a case of symptomatic SRC who underwent laparoscopic unroofing.

52 The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts

52 The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts

One-year Results of Single-session Sclerotherapy with Bleomycin in Simple Renal Cysts

PurposeTo evaluate the efficacy and safety of single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy for the treatment of simple renal cysts. Materials and MethodsA total of 66 renal cysts in 53 patients were treated by single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy under computed tomography (CT) guidance. Symptomatic (n = 31) and asymptomatic cysts (n = 22) with maximum diameters greater than 5 cm were treated. As much liquid content of each cyst was aspirated as possible, and bleomycin was injected and remained in the cyst. Follow-up was performed with ultrasonography or CT every 3 months until 1 year, and cyst volume was calculated before and after sclerotherapy. Therapeutic response was assessed by cyst volume reduction rate (VRR) and classified as complete regression (CR; ie, invisible), near-CR (ie, VRR>85%), partial regression (PR; ie, VRR of 50%–85%), or no response (NR; ie, VRR<50%). Medical records were reviewed to analyze complications. ResultsCysts refilled partially in the initial stage after sclerotherapy and decreased gradually in size over the entire follow-up period. At 1-year follow-up, the overall response rate was 98.5% (65 of 66), with CR in 31 cysts (47.0%), near-CR in 24 cysts (36.4%), PR in 10 cysts (15.1%), and NR in one cyst (1.5%). No major complications were encountered. ConclusionsSingle-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy is a simple, safe, effective, well tolerated alternative technique for management of simple renal cysts.

Conservative and radiological management of simple renal cysts: a comprehensive review

What's known on the subject? and What does the study add? Simple renal cysts are a common entity, which may need observation and follow-up or treatment. The study, for the first time, systematically reviews the indications for follow-up or radiological treatment of simple renal cysts. To review the conservative and radiological management of simple renal cysts a systematic literature review was performed. Simple renal cysts are commonly found in the adult population. Increasing age is highly associated with its incidence. When they remain asymptomatic they require neither treatment nor follow-up. When the shape of the cyst is slightly irregular follow-up is mandatory to exclude malignant progression. Symptomatic cysts require intervention. Ultrasound or computed tomography guidance have been effectively used for cyst puncture. However, simple fluid aspiration is ineffective leading to cyst recurrence. Aspiration should be accompanied with the injection of a sclerosing agent to destroy renal cyst epithelium. Several issues such as the ultimate technique and agent remain to be clarified. High rates of cyst disappearance and long-lasting cyst volume reduction have been reported with the use of various sclerosants. Ethanol in high concentrations and multiple injections is more commonly used with new agents showing similar efficacy and better complication profile. Studies comparing radiological intervention to surgical excision are lacking. Simple renal cysts may not require treatment when asymptomatic. Radiological intervention with the use of sclerosants needs further evaluation and comparison with other treatment methods.

Pure Natural Orifice Translumenal Endoscopic Surgery Management of Simple Renal Cysts: 2-Year Follow-Up Results

Retrograde ureteroscopic marsupialization is a pure natural orifice translumenal endoscopic surgery (NOTES). We retrospectively examined the feasibility and safety of this technique to manage symptomatic simple renal cysts. Sixteen patients with simple renal cysts were selected and treated by incising the cyst wall to drain into the collecting system through retrograde ureteroscopy. A retrospective observational study was performed to evaluate the patient's symptomatic and radiologic results after ureteroscopic marsupialization. Symptomatic success based on pain relief was evaluated using a visual analog pain scale preoperatively and postoperatively. Radiologic success was defined as no recurrence of the cyst or a reduction in cyst size by at least half. There were no intraoperative or postoperative complications observed. The mean operative time was 35 minutes (range 20-50 min). The mean hospital stay was 3.4 days (range 2-5 d). Of the 16 patients, one patient was lost at follow-up. The symptoms based on pain had resolved in 13 (83%) cases but remained in 2 cases at a mean follow-up of 24.2 months (range 6-36 mos). The average visual analog pain scale decreased from 6.7 (range 4-9) to 1.1 (range 0-5) at the sixth month. The mean size of all cysts decreased from 6.8 cm (range 4-10 cm) to 1.3 cm (range 0-5 cm). Radiographic success was achieved in 93% (14/15) of patients. Cytology and cyst wall pathology reports revealed no evidence of malignancy. Retrograde ureteroscopic marsupialization is a complete transurethral NOTES marsupialization. With appropriate patient selection, the minimally invasive retrograde ureteroscopic marsupialization is feasible, safe, and effective. It can be preferred to more invasive laparoscopic or open surgical approaches.

Management of simple renal cysts during percutaneous nephrostolithotomy

Simple renal cysts can coexist with renal stones. Percutaneous removal of these stones requires special considerations. We describe the management of 2 patients with this problem and propose a simple logarithm.

The Sonographic Evaluation and Management of Simple Renal Cysts in Children

Although simple cysts of the kidney are common in adults such lesions are seldom reported in children. The wider application of improving pediatric uroradiology and the increasing diagnostic accuracy of ultrasound allow more frequent recognition and better definition of these lesions.We evaluated the results of non-operative management of simple renal cysts in 7 children between 7 and 13 years old, seen at this hospital during the last 3 years. A review of the world literature indicates that management of simple renal cysts is predominantly surgical. A non-operative form of diagnosis and followup evaluation of simple renal cysts, using specific ultrasonographic techniques and criteria, are offered as the method of choice for this condition.