Peripelvic Cysts Research Articles

LAPAROSCOPIC MANAGEMENT OF COEXISTING CALYCEAL DIVERTICULUM AND PERIPELVIC CYST

You have accessJournal of Urology1 Apr 2008LAPAROSCOPIC MANAGEMENT OF COEXISTING CALYCEAL DIVERTICULUM AND PERIPELVIC CYST William J Badger and Howard N Winfield William J BadgerWilliam J Badger More articles by this author and Howard N WinfieldHoward N Winfield More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61605-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "LAPAROSCOPIC MANAGEMENT OF COEXISTING CALYCEAL DIVERTICULUM AND PERIPELVIC CYST." The Journal of Urology, 179(4S), p. 545 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 545 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information William J Badger More articles by this author Howard N Winfield More articles by this author Expand All Advertisement PDF downloadLoading ...

Case Report: Endoscopic Unroofing of Symptomatic Peripelvic Simple Renal Cyst

We report the ureteroscopic unroofing of a symptomatic peripelvic cyst with a holmium laser in a 37-year-old woman. At 1-year follow-up, the patient remains symptom free. Endoscopic management of peripelvic cysts is durable and can be performed safely.

Laparoscopic decortication of symptomatic simple renal cysts: 10‐year experience from one institution

To assess the long-term results by symptomatic and radiological outcome of laparoscopic decortication of renal cyst, first reported in 1992. We retrospectively reviewed the records of 36 patients who had a total of 36 laparoscopic decortications at our institution between December 1993 and March 2004. Of these cysts, 30 were peripheral and six were peripelvic cysts; the patients were asked if they had pain or not. Changes of cyst size after decortication were determined by computed tomography and the serial changes of each cyst were evaluated as the percentage of the diameter before surgery. The relationships between radiological and symptomatic outcome or cyst location were examined. Peri-operative morbidity was satisfactory; with a mean (range) follow-up of 67.2 (13-128) months the symptomatic and radiological success rates were 92% (33 of 36) and 81% (25 of 36), respectively. Peripelvic cysts were significantly correlated with radiological failure. Symptomatic improvement was evident by 3 months, while radiological improvement continued for up to 3-4 years after surgery. Seven asymptomatic patients with radiological failure selected a conservative follow-up. Laparoscopic decortication is safe and provides long-term satisfactory symptomatic results. The radiological improvement was slower than the symptomatic improvement and several cysts remained large, indicating some reduction in volume that was enough to improve the symptoms. This procedure is still challenging for peripelvic cysts in terms of radiological results, yet feasible for the clinical outcome.

Ultrasound guided percutaneous puncture and sclerotherapy with alcohol for peripelvic cysts

To summarize the experience of ultrasound guided percutaneous aspiration and sclerotherapy for peripelvic cysts and investigate the clinical effect. A total of 169 cases of peripelvic cyst patients were evaluated, of whom 36 cases (21.3%) had hydronephrosis secondary to peripelvic cysts, 8 cases (4.7%) had renal calculus. All patients underwent ultrasound and intravenous phelography (IVP) examination, 59 patients also had CT scan. Hydatid fluid was analyzed by amine test. Percutaneous aspiration was guided by ultrasound, 95% alcohol was used to sclerosis the peripelvic cysts when amine test was negative or positive but did not have communication with pelvis through opacification. Ultrasound were done at 1, 3, 6 months and every 1 year thereafter, follow-up period were 6 months to 5 years. One hundred and sixty-five peripelvic cysts (97.6%) were cured by once sclerotherapy, the diameter of another 4 cases (2.4%) diminished to less than 1.5 cm by once sclerotherapy. Thirty-six cases of hydronephrosis were all resolved after sclerotherapy. Eight cases had renal calculus, of whom 4 cases underwent extracorporeal shockwave lithotripsy, 2 cases underwent percutaneous nephrolithotomy, and 2 cases did not treat the stone. Five patients had gross hematuria after aspiration, but all diminished in 3-5 d. Ultrasound guided percutaneous aspiration and sclerotherapy for peripelvic cysts had the superiority of safety, effectiveness micro-invasion and low complication.

Laparoscopic management of peripelvic renal cysts: University of California, San Francisco, experience and review of literature

Objectives To report our experience and review published reports on the laparoscopic management of peripelvic renal cysts. Peripelvic renal cysts represent a unique subset of renal cysts, as they are rare, commonly symptomatic, and more difficult to treat than simple peripheral renal cysts. Minimally invasive methods for the treatment of peripelvic renal cysts, including laparoscopic decortication, have recently become more common. Methods Four patients who presented with symptomatic peripelvic cysts underwent laparoscopic decortication at our institution. All four were men aged 47 to 65 years. One patient had undergone an unsuccessful prior cyst aspiration. All patients underwent preoperative computed tomography and retrograde pyelography. The mean number of peripelvic cysts per patient was 3.0, and the mean cyst size was 7.1 cm. Results The mean operative time was 259 minutes (range 240 to 293), and the mean estimated blood loss was 30 mL (range 10 to 50). No evidence of cystic renal cell carcinoma was found on aspiration cytology or cyst wall pathologic examination. The mean hospital stay was 1.3 days. No inadvertent collecting system injuries and no intraoperative or postoperative complications occurred. All 4 patients achieved symptomatic relief and were determined to have radiologic success as determined by the 6-month postoperative computed tomography findings. Conclusions Laparoscopic ablation of peripelvic renal cysts is more difficult than that of simple peripheral renal cysts and demands a heightened awareness of potential complications and, therefore, more advanced surgical skills. In addition to our experience, a thorough review of published reports found this procedure to be safe and effective with appropriate patient selection.

Long-Term Outcome of Laparoscopic Decortication of Peripheral and Peripelvic Renal and Adrenal Cysts

We determined the perioperative course of laparoscopic decortication of renal/adrenal cysts, and the association among cyst location, radiographic assessment and long-term symptom relief. Laparoscopic cyst decortication was performed 18 times in 17 patients for pain relief (1 patient had bilateral cysts) at our institution between August 1996 and June 1999. Of these patients 13 had single and 5 had multiple cysts, and 9 each had peripelvic and peripheral (includes 2 adrenal) cysts. Questionnaires were prospectively distributed to these patients preoperatively, 2 and 6 weeks postoperatively, and annually thereafter. Preoperative and postoperative radiographs were reviewed. Perioperative morbidity measures were similar to those previously published with minimal complications and a rapid recovery. Cyst location had no significant perioperative impact. Symptom relief occurred in 78% of cases overall. Median final symptomatic followup was 52 months. Radiographic success (complete absence of cyst) was 89% for the peripheral cyst group and 55% for the peripelvic cyst group (p = 0.29). Median radiographic followup was 23 months. Symptomatic failure occurred in 40% of the 5 radiographic failures and 15% of the 13 radiographic successes (p = 0.53). Laparoscopic decortication is a safe, minimally invasive and effective treatment for symptomatic renal cysts with durable response. Although peripelvic cyst location can make certain cases more difficult or even technically not feasible, perioperative measures and long-term outcome are generally equivalent. Symptomatic failure after complete cyst resection, as measured radiographically, is likely due to a misdiagnosis of the cause of symptoms.

Reduced kidney size in patients with simple renal cysts

Renal cysts frequently occur in the absence of genetic diseases but their significance is unknown. Since multiple cysts develop in many patients with advanced renal disease, we tested the hypothesis that isolated cysts are associated with early nephron loss. All inpatient and outpatient sonograms performed by the Renal Division since 1995 were reviewed and, after exclusion of duplicate studies, patients with genetic cystic disorders, complex cysts, hydronephrosis, peripelvic cysts, end-stage renal disease and transplanted kidneys, 2526 were selected for this study, of which 385 had one or more cysts. Maximum renal length was used as an indication of size, and renal function was estimated by serum creatinine concentration. Both right and left kidney length were significantly less in patients with cysts (P < 0.0001), independent of which kidney contained the cyst(s). Renal lengths were less in patients with multiple cysts as opposed to single cysts but not in patients with bilateral cysts as compared to unilateral cysts. Cysts were twice as frequent in solitary kidneys than in dual kidneys (P = 0.01). In outpatients matched for age and gender, those with cysts had a higher serum creatinine concentration but with borderline significance (P = 0.06). Multivariate analysis revealed that age, gender, and renal length were each independent variables and together accounted for one third of the incidence of cysts. Kidney size is reduced in patients with simple renal cysts noted on renal sonography, and cysts may be associated with reduced renal function. This suggests that isolated cysts are an indication of nephron loss in patients with renal abnormalities.

Isolated type 1 renal hydatid cyst presenting as a peripelvic cyst

A man presented with a history of headaches. His blood pressure was 170/104 mm Hg. A diagnosis of peripelvic cyst was made on ultrasound (Fig. 1A), intravenous urogram (Fig. 1B), and computed tomography (CT) scan (Fig. 2). Renal scans with captopril intervention, urinary vinyl mandellic acid, and metanephrines were normal. During retroperitoneoscopic cyst deroofing, the patient developed sudden hypotension. He was resuscitated with crystalloids, hydrocortisone, and antihistamines. Exploration revealed a large hydatid cyst (daughter cysts inside) that was enucleated completely (Fig. 3). Histopathologic investigation revealed Echinococcus granulosus. The cavity was irrigated with hydrogen peroxide and povidoneiodine and the wound was closed. The patient was given albendazole for 6 months (10 mg/kg per day). There was no recurrence of cyst at 9-month follow-up.

Laparoscopic ablation of symptomatic parenchymal and peripelvic renal cysts

Objectives. To assess the safety and efficacy of laparoscopic ablation of symptomatic renal cysts as minimally invasive therapeutic techniques have largely supplanted open surgical intervention for the treatment of symptomatic renal cysts. Methods. The records of 32 consecutive adult patients who underwent laparoscopic ablation of renal cysts (11 peripelvic, 21 parenchymal) were retrospectively reviewed. All patients were symptomatic at presentation; 26 had a single cyst, 5 had two cysts, and 1 had four cysts. Results. Twenty patients underwent a transperitoneal laparoscopic approach, and 12 patients underwent a retroperitoneal laparoscopic approach. An average of 3.2 ports were used for each procedure, and no open conversions or transfusions were necessary. When comparing patients with parenchymal and peripelvic cysts, statistically significant differences were noted in the mean operative time (164 versus 233 minutes, respectively; P = 0.003) and mean operative blood loss (98 versus 182 mL, respectively; P = 0.04). Four patients (13%) had complications (one major and three minor), including a persistent ureteral stricture. One patient with negative preoperative aspiration cytology and negative intraoperative frozen section analysis was later found to have malignancy within the cyst wall, necessitating radical nephrectomy and trocar site excision. One patient (3%) developed a recurrence. Conclusions. Laparoscopic ablation of symptomatic renal cysts is a safe and efficacious procedure. We report an overall complication rate of 13% and a recurrence rate of 3% with a mean follow-up of 18.1 months (median 10.0).

Laparoscopic management of renal cystic disease

Laparoscopic management of renal cystic disease is a highly effective, safe, and minimally invasive alternative to open surgery and antegrade or retrograde endoscopic procedures. Simple renal cysts can be accessed either transperitoneally or retroperitoneally. Almost all studies of the laparoscopic approach have demonstrated great satisfaction in terms of efficacy, minimal complications, operative time, minimal blood loss, hospital stay, recuperation, and cosmesis over other methods of treating renal cysts. Laparoscopic unroofing of peripelvic cysts is more challenging owing to their proximity to hilar vessels and the collecting system. Such surgery should be considered an advanced laparoscopic procedure. Access may be achieved either transperitoneally or retroperitoneoscopically. The basic principle of adequate exposure is essential for effective treatment. If the cyst is not completely excised, the surgeon must fulgurate the edge and tack perirenal fat in the residual cyst cavity to prevent recurrence and facilitate drainage. Laparoscopic evaluation of complex cysts seems to be sound. The results are promising, and follow-up does not show any increase in peritoneal seeding, tract recurrence, or distant metastases in the small number of neoplasms diagnosed at laparoscopy. Nevertheless, more studies are required with long-term follow-up. Bosniak type IV renal cysts or malignancy in renal cysts can be managed by laparoscopic radical nephrectomy with either access. Laparoscopic cyst marsupialization in patients with ADPKD is the latest emerging indication for laparoscopy in renal cystic disease. This procedure not only effectively reduces pain in some patients but also improves hypertension and stabilizes renal function, delaying renal replacement therapy. Long-term follow-up and further evaluation are needed.

The role of retroperitoneoscopy in the management of renal and adrenal pathology.

To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys. Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys. Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days. Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.

LAPAROSCOPIC ABLATION OF PERIPELVIC RENAL CYSTS

We describe and define the operative techniques, findings and results of laparoscopic ablation of peripelvic renal cysts. One male and three female patients, ranging in age from 35 to 59 years, underwent laparoscopic ablation of symptomatic peripelvic cysts. All patients had symptoms of ipsilateral flank pain and obstruction. One patient had an episode of pyelonephritis before detection of the cyst, and 2 patients had concomitant stones within the obstructed system. Cysts ranged in size from 4 to 6 cm. Dissection was uniformly complex because of the depth to which the cyst extended into the renal parenchyma and the overlying renal vessels and collecting system. Operative times ranged from 315 to 390 minutes (mean 338 minutes). The average length of hospital stay was 2.75 days (range 2 to 4 days). Three of 4 patients (75%) had resolution of their symptoms and collecting system obstruction. One patient, the only case of a retroperitoneal approach, had recurrence of her symptoms and cyst 2 months after the operation and required open surgical repair. Laparoscopic ablation of peripelvic cysts is a challenging yet feasible procedure. Because of the medial location of these cysts, a transperitoneal approach may be preferable to retroperitoneal access alone.

Peripelvic cysts simulating hydronephrosis

Peripelvic cysts can have a sonographic appearance that is similar to hydronephrosis. Two cases are described where the initial sonogram suggested the diagnosis of pelvicalyceal obstruction, and on subsequent intravenous urography the correct diagnosis of peripelvic cysts was made.

Sonographic features of renal obstruction mimicked by peripelvic cysts

Peripelvic cysts can closely mimic the sonographic changes of renal pelvicalyceal dilatation. Three cases are described in which a particular feature was the presence of linear septations extending to the hilum which represented the walls of tubular peripelvic cysts. The cluster of cysts centrally in the renal sinus was originally interpreted as a dilated pelvicalyceal system. Excretion urography is usually necessary to exclude pelvicalyceal dilatation conclusively.

Laparoscopic Ablation of Symptomatic Renal Cysts

We report a laparoscopic approach to the drainage and ablation of symptomatic simple renal cysts. Ten patients with chronic pain, 6 of whom failed primary aspiration, underwent laparoscopic cyst ablation: 6 had solitary renal cysts, 3 had multiple cysts and 1 had a peripelvic cyst. The approach was transabdominal in 9 patients and extraperitoneal in 1. Intraoperatively, cyst fluid was obtained for cytological examination, and cyst walls were excised and sent for pathological examination. When possible, the remaining inner cyst walls were fulgurated to prevent recurrence. Mean total operating room time was 2hours 27minutes and blood loss was minimal. The sole complication was a postoperative retroperitoneal hematoma, which was managed conservatively. Malignancy was diagnosed in 2 patients, each of whom had a negative preoperative aspiration. These patients subsequently underwent radical nephrectomy. All remaining patients were asymptomatic at a mean followup of 10 months. Laparoscopic ablation of renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Preoperative and intraoperative evaluation for malignancy should be performed.

Nephroscopic Obliteration of Obstructing Peripelvic Renal Cyst in Conjunction with Stone Removal

We report one case in which an obstructing peripelvic cyst was resected nephroscopically through the renal pelvis and two lower caliceal stones were removed by a single access. Extensive fulguration of the cyst was carried out, and a catheter was left in the cyst cavity for 7 days to promote fibrosis and shrinkage. A postoperative nephrostogram and CT follow-up at 21 months revealed unobstructed flow and no recurrence of the cyst.

CT and Ultrasonography of Acute Renal Abnormalities

Computed tomography and ultrasonography are important in the evaluation of patients with acute renal abnormalities, either as adjuncts or, less commonly, as alternatives to excretory urography. Ultrasonography has become the imaging procedure of choice in evaluation of acute renal failure. Detection of obstructive uropathy by ultrasonography is very accurate, although the potential pitfalls of minimal dilatation obstructive uropathy, false absence of caliectasis in dehydrated patients, and peripelvic cysts simulating hydronephrosis should be considered. Both CT and ultrasonography have improved our ability to define specific causes of intrinsic or extrinsic renal or ureteral obstructing lesions, including tumor, inflammatory masses, and calculi. Renal infections and infarctions also have characteristic appearances on CT and ultrasonography, though ultrasonography is somewhat limited by its inability to reliably demonstrate gas-containing or small abscesses, and its inability to provide functional information about the concentrating capacity of regional areas of the kidney.

The spectrum of peripelvic cysts.

Nineteen peripelvic cysts with unusual findings are discussed. While usually an incidental radiographic finding, these cysts may obstruct the collecting system and yet not be apparent on nephrotomography. They may also be confused with renal sinus lipomatosis and, ultrasonographically, they may mimic hydronephrosis.

USE OF COMPUTERIZED TOMOGRAPHY IN THE EVALUATION OF FILLING DEFECTS OF THE RENAL PELVIS

AbstractComputerized tomography has been used in the evaluation of 5 patients with radiolucent masses of the collecting system. There were 3 cases of renal calculi, 1 peripelvic cyst and 1 squamous cell carcinoma of the renal pelvis. The results of computerized tomography scanning are correlated with the results of excretory urography and ultrasonographic scanning. The diagnostic advantage of computerized tomography scanning for evaluation of radiolucent masses of the upper collecting system is elucidated.

Peripelvic cysts: an impostor of sonographic hydronephrosis.

Static and real-time ultrasound examinations have proved clinically useful in the evaluation of renal obstruction. False-negative findings are rare. False-positive findings have been reported as being due to slightly dilated, nonobstructed urinary systems causing the ultrasonographic appearance of mild (grade I) hydronephrosis. The authors describe the ultrasonographic appearance of 16 false-positive cases that had suggested moderate (grade II) to severe (grade III) hydronephrosis in collecting systems subsequently shown to be completely unobstructed. This appearance was caused by peripelvic cysts. These cases emphasize the screening role of ultrasound and the need to employ additional diagnostic modalities to verify the presence of hydronephrosis and renal obstruction.