Parapelvic Cysts Research Articles

Renal involvement in leprosy: evaluation of patients in Turkey

IntroductionRenal involvement in leprosy has previously been described in the literature and can include amyloidosis, glomerulonephritis, nephrosclerosis, tubulointerstitial nephritis, and granulomas.AimTo evaluate renal involvement in Turkish patients with leprosy.Material and methodsIn total, 32 patients with lepromatous leprosy but without any co-morbidities and 35 healthy control subjects were evaluated for renal involvement at the Elazig Training and Research Hospital in Turkey. The laboratory tests and radiological results concerning renal function were taken from both the patients’ medical records and from current examinations.ResultsThe levels of creatinine, urea, and leukocyturia in the lepromatous leprosy patients were significantly higher than in the controls (p < 0.001, p < 0.001; p = 0.001, p < 0.01; p = 0.036, p < 0.05, respectively). No significant differences in the proteinuria, hematuria, sodium, or potassium levels were found between the leprosy and control groups (p > 0.05). On ultrasonographic examination, the prevalence of renal cortical cysts and renal cortical echogenicity in the leprosy patients was significantly higher than in the controls (p = 0.020, p < 0.05, respectively). There were no significant differences in terms of nephrolithiasis, parapelvic cysts, or hydronephrosis between the leprosy and control groups (p > 0.05).ConclusionsEvaluating the renal function in all leprosy patients is important to detect abnormalities and to prevent renal failure, which remains a potential cause of death in this disease.

Transperitoneal laparoscopic parapelvic cyst unroofing of 45 cases

Objectives To evaluate the experience and clinical efficacy of transperitoneal laparoscopic parapelvic cyst unroofing. Methods From 2008 to 2015, 45 cases of transperitoneal laparoscopic parapelvic cyst unroofing were collected. Of all the cases, 33 males and 12 females, aged from 35 to 65 years, and 27 patients in left, 18 patients in right. Results All of these 44 operations were successful, no cases convert to open surgery. 1 case for kidney seeper was misdiagnosed as renal pelvis cyst. And double J tube was placed intraoperative and no leakage of urine. All of these cases had no complications after sutured.The average operation time was 35min. No obvious activity bleeding occured, and the average hospital stays after operation was 3~5 d. Histological studies showed 44 cases parapelvic cyst. Clinical symptoms repeatedly and recurrence under the imaging diagnosis were found during 3~18 months' follow-up in 45 cases. Conclusions The transperitoneal laparoscopic parapelvic cyst unroofing have the advantages of clear surgical field, less trauma and rapid recovery. It is an effective treatment for the renal pelvis cyst. Key words: Kidney Pelvis; Cysts; Laparoscopes

The Novel Use of Flexible Ureteroscopy and Holmium: YAG Laser in the Management of Parapelvic Renal Cysts

Kidneys are very common sites of cysts in the human body, prevalence of renal cysts was estimated to be about 10% in the general population and the incidence increases with age. Parapelvic and peripelvic cysts grow near renal collecting system; these types of cysts are most likely to be symptomatic. There are a number of reports describing successful laser incision drainage of parapelvic cysts into the renal pelvis using flexible ureteroscopy transurethrally. This review focuses on specific aspects of clinical usage and novelty of flexible ureteroscopy and holmium laser in the management of parapelvic cysts. A systematic review of articles written in the English language on the subject appearing in the medical journals was conducted using Medline database. Cysts that grow near and inside renal pelvis almost always present with symptoms and require treatment intervention. The intervention is guided by the size of the cyst and severity of the symptoms. Flexible ureteroscopic holmium laser marsupialization of parapelvic cysts is less morbid and complications when compared to laparoscopic decortication approach which is technically very challenging due to the locations of these types of cysts. Retrograde marsupialization of parapelvic cysts is a novel technique which does not need any skin incision at all, thus improving cosmesis after surgery. This approach is a pure and of classical natural orifice transluminal endoscopic surgery (NOTES), it reduces morbidity, mortality, and surgical complications.

Renal cysts: Sonographic evaluation and classification in Sudanese adults

Background: Renal cysts were common findings in the kidneys encountered in daily routine ultrasound examination. The majority is benign, but they can become complicated in the case of infection, hemorrhage, and ischemia. Sonographic evaluation plays a great role in classification and characterization of these lesions. Objective: The aim was to classify the renal cysts using ultrasound, to analyze the frequency of symptoms and signs, and to identify the significant factors. Materials and Methods: This is a cross-sectional prospective study conducted from September 2014 to December 2015. A total of 105 patients (78 males and 27 females) have been examined with ultrasound and confirm diagnosed with renal cysts. The sonographic criteria used for assessing renal cysts were wall-definition, thickness of septa, acoustic enhancement, shape and numbers of cysts, in addition to the genetic history of the family. Results: The incidence of renal cysts is significantly higher in male than female (74% vs. 26%, P = 0.01). Renal cysts were common in patients above 50 years old (80%). Aging was a significant factor of the renal cyst ( P = 0.03) and size of the cysts was not significantly associated with age ( P = 0.261). The majority of cysts was solitary (66%), unilateral (86%), and located in the right kidney (49%). The incidence of cortical simple renal was 73%, para-pelvic simple cysts was 17%, autosomal-dominant polycystic kidney disease (ADPKD) was 4.76%, and acquired cystic kidney disease (ACKD) was 4.76%. The majority of simple renal cysts were asymptomatic (75%). Hypertension and flank pain were the common symptoms of ADPKD and ACKD. Conclusion: Age and gender were significant risk factors of renal cysts. ADPKD and ACKD were less frequent among Sudanese adults. Hypertension and flank pain were the most common symptoms and signs of ADPKD and ACKD. Ultrasound plays an effective role to classify and assess renal cysts that help in management and follow-up.

Renal Stones Outlet Obstructed by Pararenal Pelvic Cyst Management

s / Urological Science 26 (2015) S50eS81 S54 plane abdominal X-ray. Treatment outcomes, including disintegration rate, stone-free rate, and retreatment rate, for both groups were also compared. Results: Pre-SWL, the patient characteristics, treatment parameters, and stone-related parameter were similar for both groups. There were higher stone-free and disintegration rates in the electrohydraulic group for most stones, but the retreatment rate was higher in the electromagnetic group. There was no significant difference for stones at the middle and lower ureter and stones in the ureter bigger than 1 cm. The complication rates for pain, skin, or subcapsular hematoma were not significantly different between groups. Conclusion: The electrohydraulic lithotriptor (Medispec E3000) group has significantly higher disintegration and stone-free rates, but has similar complication rates compared to the electromagnetic lithotriptor (Medispec EM1000) group. There is no significant difference between the two groups for middle or lower ureteral stones and ureteral stones bigger than 1 cm. The electromagnetic lithotripter has the advantage of being useful for SWL even without anesthesia. NDP017: RENAL STONES OUTLET OBSTRUCTED BY PARARENAL PELVIC CYST MANAGEMENT Ping-Ju Tsai, Cheng-Chen Su, Chung-Sung Shen, Shih-Ya Hung. Division of Urology, Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan We often incidentally indentified some renal cysts at OPD. The principles of non-obstructive simple renal cysts management is watchful waiting. However, some renal cysts need to be managed, such as malignancy tendency, renal pelvic-ureteral junction obstruction by those cysts. The management of renal cysts included aspiration combined with injection of scloerosing materials, and laparoscopic unroofing. We presented a 60-year-old male who has multiple low calyceal stones with focal hydrocalyx. The renal pelvic-ureteral junction was extrinsic compressed by one large parapelvic renal cyst. First, non-enhanced abdominal CT scan was arranged and thus we clearly know the relative locations of cyst and pelvic-ureteral junction. Laparoscopic unroofing of renal cyst was performed. After surgery, we arranged intravenous pyelogram for confirming the pelvic-ureteral junction patency. Watchful waiting for spontaneous passage of multiple small renal stones was planned. Unfortunately, stone streets formations in low third and upper third ureter were found later. Ureteroscopic lithotripsy and double-J catheter were performed smoothly. Extraperitoneal shock wave for residual renal stones was performed, too. Last, we removed the double-J catheter. The clearance of renal stone was excellent.

Relationship between divided-shaped kidney and collecting system duplication.

We aimed to assess the incidence of divided-shaped kidney and the relationship between divided-shaped kidney and collecting system duplication. Between May 1 and June 30, 2012, 857 patients (men:women, 493:364; mean age 39.6years; age range 2-98years) with 1699 kidneys underwent enhanced computed tomography of the abdomen and pelvis at our institution. Sixty kidneys were excluded (tumor, 3; percutaneous nephrostomy, 9; polycystic kidney disease, 4; renal injury, 1; infarct, 1; hydronephrosis, 18; parapelvic cyst, 17; artifact, 5; horseshoe kidney, 2). Finally, 845 patients and 1639 kidneys were included. The number of cases of prominent column of Bertin (divided by grade of prominence as either divided-shaped kidney or hypertrophy) and collecting system duplication (bifid, partial, and complete) were evaluated. Fisher exact test was used to determine the relationship between divided-shaped kidney and collecting system duplication, and between hypertrophy and collecting system duplication. Of 1639 kidneys, 66 (4%) were divided-shaped kidneys, and 88 (5%) had collecting system duplication (bifid, 69; partial, 19; complete, 0); among the 66 divided-shaped kidneys, 28 (42%) had collecting system duplication. Among the 429 cases of hypertrophy and 1144 normal kidneys, 51 (11.9%) and 9 (0.8%) had collecting system duplication, respectively. The incidence of divided-shaped kidney was 4%, and there was a significant association between divided-shaped kidney and collecting system duplication.

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Diagnostic value of excretory phase in CT urography

Objective To determine the diagnostic value and necessity of excretory phase of CT urogrphy (CTU). Methods One hundred and one cases with 197 sides of cohort CTU studies were enrolled from PACS system retrospectively, and 44 cases had the records of radiation dosage. Three different seniority senior radiologists reviewed the images and diagnosed 2 times blindly with the clinical information. At the first time, plane scan, contrast enhanced renal cortical phase and renal parenchymal phase images (Diag. A) were reviewed. At the second time, with 3 kinds of images mentioned above plus excretive phase images (Diag. B) were reviewed, with interval of 3 months between the two reviews. With Diag. B as reference standard, accordance rate of diagnoses of Diag. A was calculated. The difference of the 3 rediologists's accordance rates were analyzed with Chi-square test, and the lesions with accordance rate ≤80% were recorded. The cases of 197 urinary tracts were divided into 4 groups: lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion. The filling of contrast media in the urinary tract was recorded with 5-scale scoring system. The differences of the urinary tract filling among the 4 groups were analyzed with Kruskal-Wallis test. The effective radiation dosages of CTU with and without excretory phase scan were recorded and calculated, and the difference was analyzed with t test. Result The diagnostic accordance rate of CTU with and without excretory phase of the 3 radiologists was 95.4% (188/197), 93.9%(185/197), 92.4%(182/197)respectively(χ2=1.60, P>0.05). Lesions with diagnostic rate ≤80% were parapelvic cyst and caliceal diverticulum. The median score of urinary tracts filling in the lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion group were 2, 3, 3, 4, and the differences were significant (HC=31.7, P<0.05). The effective radiation dosages of CTU with and without excretory phase scan were (32.36±11.04)mSv and (41.47±14.27) mSv respectively (t=3.35, P<0.01). Conclusions No significant effect of excretive phase imaging is found on the diagnosis of most urinary system diseases. Poor contrast filling and high rate of failure of filling of the urinary tract with intra luminal pathologies, and increase of the radiation dosage make the excretory phase scan in CTU less useful and it should be used carefully and selectively. Key words: Ureter; Tomography, X-ray computed; Radiation dosage

Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study.

IntroductionLaparoscopic pyeloplasty is considered a standard treatment for ureteropelvic junction obstruction (UPJO). However, the presence of another pathology makes it a more challenging operation and guides the surgeon towards open conversion. In this study, we present our experience in difficult pyeloplasty cases managed by laparoscopy.Material and methodsSix patients (4 females and 2 males) with an average age of 44 and a range of 27 to 60 years old, were diagnosed for UPJO. Three were on the left side and 3 on the right side. In addition to UPJO, 2 patients had renal stones, one patient had both renal ptosis and an umbilical hernia, 3 patients had a para-pelvic cyst, hepatomegaly and malrotated kidney, respectively. All patients had a preoperative ultrasound, CT or IVU, and a renal isotope scan. Laparoscopic pyeloplasty was performed according to the dismembered Anderson-Hynes technique with auxiliary maneuver, according to the pathology.ResultsAll patients were treated successfully for UPJO and the concomitant pathologies, except hepatomegaly and malrotation. Mean operative time was 125 minutes and estimated blood loss was <50 ml.ConclusionsLaparoscopic pyeloplasty can be performed in difficult situations provided that the surgeon has enough experience with laparoscopy.

Treatment of Parapelvic Cyst by Internal Drainage Technology Using Ureteroscope and Holmium Laser.

The aim of parapelvic cyst treatment is to have complete drainage of cyst fluid and prevent its further compression of the kidney and collective system. This study explores the efficacy and safety of surgical approaches with holmium laser ureteroscopic internal drainage in the treatment of parapelvic cyst. The compression effect of parapelvic cyst on the renal collective system was observed by rigid ureteroscope using retrograde ureteroscopic technology. With direct vision, the cyst wall on the obvious parapelvic compression site was cut. The diameter of the cyst wall cut was about 1 cm. The internal drainage was obtained by double-J tubes. When the cyst was in the inferior pole of kidney or where the rigid ureteroscope could not reach, a flexible ureteroscope was used. In 28 cases of operation, 27 cases were successful. The cyst treatment time was eight to 40 minutes (average 26 minutes). During the operation, no massive haemorrhage, damage of nearby organ and ureter, or other complications happened. Time of follow-up was 10-72 months (average 39 months). The results of follow-up showed that in 22 cases, the cyst disappeared; the diameter of the cyst in four cases was reduced by more than half, and one case recurred. The treatment of parapelvic cyst by internal drainage operation using holmium laser and ureteroscopy was effective. The operation was safe with few complications.

Treatment of renal parapelvic cysts with a flexible ureteroscope.

The aim of this study was to assess efficacy and safety of a flexible ureteroscope to treat renal parapelvic cysts. Treatment goals included avoidance of injury to renal vessels or hilar structure and minimizing the recurrence of cysts. Renal parapelvic cysts from 15 patients that were incised and drained with a flexible ureteroscope were evaluated retrospectively between October 2011 and May 2013. Mean operation time, estimated blood loss and time of hospital stay were evaluated. Symptomatic and radiologic results, conducted by computed tomography or color Doppler ultrasound, were analyzed after surgery. According to the Dindo-Clavien classification, no major complications were observed during the different types of surgery. One patient exhibited red hematuria (mild), while bladder irritation symptoms (mild) occurred in three cases in the hospital and in two cases in the first postoperative month (moderate). Average total operation times, mean duration for the incision in the renal parapelvic cyst wall and mean estimated blood loss were 31 ± 8 min, 13 ± 2 min and 20 ± 5 ml, respectively. Mean hospital length of stay was 3 days. Radiologic success was defined as no recurrence of the cyst or a reduction in cyst size by at least half. In one case, cyst size did not reduce to half of the previous size, whereas cyst sizes were reduced to less than half of the previous size in four cases. No cysts were detected in the other cases after 6 or 12 months. Feasibility, safety and efficacy of the flexible ureteroscope for treatment of retrograde renal parapelvic cysts were demonstrated using appropriate patient selection and skilled surgical technique.

Parapelvic cyst misdiagnosed as hydronephrosis.

A 37-year-old male was referred to our hospital due to an abnormal ultrasound report of the right kidney in a regular health examination. The patient was asymptomatic and did not report fever, flank pain or dysuria. Repeated ultrasonography at our hospital revealed a hypoechoic area in the right central renal sinus, suggesting right hydronephrosis, but the obstructive site could not be found (Figure 1). Urinalysis revealed clear urine, and urine cytology was negative for malignant cells. For further evaluation of the obstructive site for the hydronephrosis, a computed tomography (CT) scan was arranged (Figure 2). It revealed a parapelvic cyst with mild displacement of the collecting system but no hydronephrosis was noted. As there were no symptoms, the patient was followed up without further treatment. Fig. 1. Renal ultrasonography revealed a hypoechoic area at central sinus region, suggesting hydronephrosis. Fig. 2. (A) Non-contrasted CT scan revealed a hypodense ovoid lesion in the right renal pelvis. (B) Excretory phase of contrasted CT revealed non-enhancement of the lesion. (C) CT urography (CTU) revealed mild displacement of the contrast-enhanced collecting ... Parapelvic cysts are uncommon and found in ∼1.25–1.5% of autopsy cases [1]. Parapelvic cysts are usually solitary, originating from renal parenchyma and protruding into the sinus. Because of the hypoechoic character by ultrasonography and the special location in the renal sinus, parapelvic cysts are often misdiagnosed as hydronephrosis [2]. A large parapelvic cyst may sometimes compress the collecting system causing hydronephrosis, which needs surgical intervention [3]. Parapelvic cysts are rare and often benign and must be differentiated from hydronephrosis. The possibility of a parapelvic cyst must be kept in mind when the asymptomatic hydronephrosis is noted by ultrasonography with unknown causative obstructive lesion. Further image study such as CT scan is needed for the correct diagnosis.

Characteristics of Renal Cystic and Solid Lesions Based on Contrast-Enhanced Computed Tomography of Potential Kidney Donors

The presence of a few renal cysts is considered of little relevance in healthy adults, although acquired renal cystic disease occurs in advanced kidney failure. The objective of this study was to detail renal cystic and solid lesions and identify any association with clinical characteristics. Clinical-pathologic correlation. Potential kidney donors undergoing a standardized evaluation at the Mayo Clinic in 2000-2008. Age, kidney function, and chronic kidney disease risk factors. Renal cystic and solid lesions by contrast-enhanced computed tomographic images. Cyst number, diameter, and location. After excluding 8 with cystic disease, 7 of whom had autosomal dominant polycystic kidney disease, there were 1,948 potential kidney donors (42% men; mean age, 43 years). A cortical, medullary, or parapelvic cyst ≥5 mm was present in 12%, 14%, or 2.8%. For ages 19-49 years, 39%, 22%, 7.9%, and 1.6% had a cortical or medullary cyst ≥2, ≥5, ≥10, and ≥20 mm in diameter. For ages 50-75 years, 63%, 43%, 22%, and 7.8% had a cortical or medullary cyst ≥2, ≥5, ≥10, and ≥20 mm in diameter. The 97.5th percentile for number of cortical and medullary cysts ≥5 mm increased with age (10 for men and 4 for women in the 60- to 69-year group). After age and sex adjustment, cortical and medullary cysts ≥5 mm were associated with higher 24-hour urine albumin excretion, as well as increased body surface area, hypertension, and higher glomerular filtration rate in some analyses. Angiomyolipomas, hyperdense cysts, and enhancing masses or cysts with concerning features for malignancy occurred in 2.2%, 1.2%, and 0.6% and were associated with older age (P ≤ 0.05 for each). Persons with known chronic kidney disease were excluded. Renal cysts are common, particularly in older men, and may be a marker of early kidney injury because they associate with albuminuria, hypertension, and hyperfiltration.

A Randomized Study of Aspiration and Sclerotherapy Versus Laparoscopic Deroofing in Management of Symptomatic Simple Renal Cysts

To perform a prospective randomized study to evaluate aspiration and sclerotherapy vs. laparoscopic deroofing in the management of symptomatic simple renal cysts. Forty patients with symptomatic simple renal cysts were randomized to treatment either by ultrasonography-guided aspiration and sclerotherapy (group A-20 patients) or by laparoscopic deroofing (group B-20 patients). Two patients in group A and one patient in group B had a parapelvic cyst. Patients were evaluated by urine analysis, serum creatinine level, coagulation profile, ultrasonography, and CT urography. In group A patients, after aspiration, 1% polidocanol in a volume equivalent to 10% of cyst volume was instilled. In group B patients, laparoscopic deroofing was performed. All patients were followed up by ultrasonography up to 1 year after treatment. In group A, aspiration and sclerotherapy was performed on an outpatient basis, and none of the patients needed postoperative analgesia. Eighteen of 20 patients had complete regression; two of these had parapelvic cyst. Partial regression with relief of pain was noted in one patient, whereas treatment failed in one patient. None of the patients had any significant complication and none required analgesia. All the patients were discharged two hours after the procedure. In group B, laparoscopic deroofing was successfully performed in 19 of 20 patients. Laparoscopic deroofing could not be performed in one patient with parapelvic cyst because of failure of access. The mean analgesic requirement was 285 ± 57.98 (200-400) mg tramadol, and average hospital stay was 2.1 ± 0.32 (2-3) days. Percutaneous aspiration and sclerotherapy with polidocanol is an effective, safe, and minimally invasive therapeutic option for symptomatic simple renal cysts, with equal efficacy and lower morbidity and hospital stay in comparison with laparoscopic deroofing.

Minimally invasive percutaneous ablation of parapelvic renal cysts and caliceal diverticula using bipolar energy

Minimally invasive percutaneous ablation of parapelvic renal cysts and caliceal diverticula using bipolar energy

A clinical analysis of multilocular cystic renal cell carcinoma and its correlation with mutation of the von Hippel-Lindau gene

Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC. Key words: Kidney diseases, cystic; Carcinoma, renal cell; Hippel-Lindau disease; Genes; Mutation

Nodular parenchymal amyloid, an unusual cause of multiple pulmonary nodules with favourable long term prognosis

A previously healthy 80-year-old woman was diagnosed with an incidental right-upper-lobe (RUL) opacity on a plain chest radiograph (CXR) in 1992. She had never smoked. Surveillance radiographs over 9 months remained unchanged and she was discharged. A repeat CXR in 1996 following a productive cough, but no haemoptysis or weight loss, suggested a slight increase of the RUL lesion. Her father and mother died of lung cancer and leukaemia, respectively. Physical examination was unremarkable. Screening blood tests were normal except for an elevated IgM of 7.7 g/dl (normal range 0.3–1.4). Serum electrophoresis showed no paraprotein band and urinary Bence-Jones protein was undetected. Thoracic and abdominal computerized tomographic (CT) scans were reported as showing multiple spherical/lobular masses throughout the right lung (largest 1.7 cm in diameter), a liver cyst and para-pelvic renal cyst. A percutaneous CT-guided …

MR Imaging Guided Percutaneous Nephrostomy using a 1.0 Tesla Open MR Scanner

The purpose of this study was to assess the safety and feasibility of MR-guided percutaneous nephrostomy (PCN) using a 1.0 Tesla open MR-scanner with fast dynamic imaging. Twenty-five patients with failed ultrasonographic insertion due to various reasons, such as nondilated pelvic systems, obesity, and parapelvic cysts, were investigated. In summary, 35 nephrostomy procedures were performed; 15 patients received monolateral and 10 patients bilateral placement. For guidance and monitoring, fast T2w single-shot-TSE imaging in a fluoroscopic mode in two orthogonal planes was used to guide the insertion of the needle into a predetermined calyx in freehand technique. Nephrostomy was inserted via Seldinger-technique. The procedure was regarded as technically successful if the placement of the catheter provided adequate drainage of the collecting system. Demonstration of an intrapelvic position of the catheter was verified by antegrade pyelography using T1w GRE imaging after injection of diluted Gd-DTPA into the collecting system. Under the experimental conditions of the study, the time for the complete procedure was 30 (range, 23-39) min. Puncture and placement of the nephrostomy was performed in 5 (range, 3-10) min on average. Our results demonstrated a pinpoint puncture of the pelvic system in a reasonable timeframe even in patients with difficult conditions, suggesting that MR-guided PCN using the open 1 Tesla system can be assessed as a reliable, fast, and safe method applicable in the clinical routine setting.

Ureteroscopic Management of Symptomatic, Simple Parapelvic Renal Cyst

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.

726 RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY USING A THREE-PORT TECHNIQUE: SURGICAL EXPERIENCE AND OUTCOMES

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy I1 Apr 2010726 RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY USING A THREE-PORT TECHNIQUE: SURGICAL EXPERIENCE AND OUTCOMES Andrew I. Fishman, David A. Green, Srinivas Rajamahanty, and Michael Grasso Andrew I. FishmanAndrew I. Fishman More articles by this author , David A. GreenDavid A. Green More articles by this author , Srinivas RajamahantySrinivas Rajamahanty More articles by this author , and Michael GrassoMichael Grasso More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1214AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present outcomes and results in 62 consecutive patients who underwent retroperitoneal laparoscopic pyeloplasty (RLP) for the treatment of congenital ureteropelvic junction obstruction (UPJO) performed during an 80-month period at our institution. METHODS We performed a retrospective analysis of 62 consecutive patients that underwent RLP between February 2003 and October 2009. All procedures began with cystoscopy and stent placement. A retroperitoneal dismembered pyeloplasty was routinely performed creating a dependant funneled repair most commonly using three ports. The UPJ was meticulously dissected to define crossing renal vasculature. Vessel transposition was not routinely performed. Concurrent pyelolithotomy and parapelvic cyst resection were performed when necessary. Patients were followed with serial diuretic renal scan. RESULTS Data is presented in Table 1. All 62 cases were performed via a retroperitoneal laparoscopic approach. Mean patient age was 44.5 years. Mean operative time was 239 minutes. Crossing vessels were encountered in 74.2% of cases. In 5 cases coexisting renal calculi were successfully removed. In 4 cases coexisting parapelvic cysts were resected. The overall complication rate was 9.7% and the open conversion rate was 0%. Mean postoperative hospital stay was 2.4 days. The success rate at a median follow-up of 55.9 months was 98.4%. Overall Number of Patients (N) 62 Mean Age (Y) 44.5(5-86) Presenting Symptom Flank Pain 43(69.3%) Incidental 6(9.7%) Pyelonephritis/UTI 5(8.1%) Microhematuria 5(8.1%) Previous Urologic Surgery None 30(48.4%) Stent 20(32.3%) Endopyelotomy 6(9.7%) Type of Repair Dismembered 57(91.9%) Y-V 4(6.5%) Heineke-Mikulicz 1(1.6%) Concomitant Procedures Stone Treatment 5(8.1%) Parapelvic Cyst Resection 4(6.5%) Partial Nephrectomy 2(3.2%) Lymph Node Dissection 2(3.2%) Crossing Vessels 46(74.2%) Open Conversion 0 Mean Hospital Stay(D) 2.4(1-6) Complications: Clavien System 6(9.7%) Grade 1 2 Grade 2 1 Grade 3 3 Grade 4 0 Grade 5 0 Median Follow up(M) 55.9 Successful 61(98.4%) CONCLUSIONS With its high success rate, infrequent complications, and short hospital stay, retroperitoneal laparoscopic dismembered pyeloplasty is our first line therapy for patients with congenital ureteropelvic junction obstruction. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e283-e284 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew I. Fishman More articles by this author David A. Green More articles by this author Srinivas Rajamahanty More articles by this author Michael Grasso More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...