Peripelvic Renal Cyst Research Articles

Flexible ureteroscopic incision and drainage or laparoscopic unroofing for the parapelvic renal cysts: A systematic review and meta‑analysis.

The aim of the present study was to compare flexible ureteroscopy and laparoscopy in the treatment of peripelvic renal cysts, so as to determine the best treatment method for patients with peripelvic renal cysts. A systematic search of the PubMed, EMBASE, Cochrane Library, CONAHL, Clinicaltrials.gov, Google Scholar, CNKI and WanFang DATA databases was conducted for articles published over 22 years (December 1980-December 2022) using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. By searching the database, a total of 594 studies were found, of which eight were analyzed as evidence. A total of 394 patients were included in the present study. Of these, 193 were treated laparoscopically and 201 were treated by flexible ureteroscopy. In terms of analysis results, radiation reexamination after laparoscopic therapy had a higher success rate. Ureteroscopy has advantages in the time spent in the operation, the amount of blood lost during the operation, the time to recover the anal exhaust after the operation and the length of postoperative hospital stay. There were no significant difference in postoperative recurrence or complications between the two surgical methods. After comprehensive analysis, it was considered that flexible ureteroscopy has more advantages in the treatment of peripelvic renal cyst, which is mainly manifested in the duration of operation, the total amount of blood loss during operation, the interval of recovery of anal exhaust after operation and the total length of postoperative hospital stay. It is worth further exploration and promotion.

255 A Peripelvic Renal Cyst Resulting in Clinically Symptomatic Ureteropelvic Junction Obstruction

255 A Peripelvic Renal Cyst Resulting in Clinically Symptomatic Ureteropelvic Junction Obstruction

‘All that glitters is not gold’: when hyperammonaemia is not from hepatic aetiology

Hyperammonaemia is often caused by decompensated liver disease. However, non-hepatic causes can sometimes result in hyperammonaemia, severe enough to cause symptoms.We report a case of a 65-year-old man with a...

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.

Retroperitoneoscopic Decortication of Symptomatic Peripelvic Renal Cysts: Chinese Experience

To report our single-center experience of retroperitoneoscopic renal cyst decortication in the treatment of symptomatic peripelvic renal cysts. From January 2003 to July 2010, 36 patients with symptomatic peripelvic renal cysts, mean size 7.9 cm (range 5.8-12), underwent retroperitoneoscopic cyst decortication. The patients with complex renal cysts were excluded. Of the 36 patients, 2 had undergone an unsuccessful previous cyst aspiration. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was defined as no recurrence on the most recent computed tomography scan. Retroperitoneoscopic renal cyst decortication was successful in all patients. No open conversions or transfusions were necessary. The mean operative time was 159 minutes (range 113-189), and the mean estimated blood loss was 55 mL (range 20-78). The mean hospital stay was 3.5 days. In 2 patients, the collecting system was entered, and a double-J stent, which drained the pelvis for 4 weeks, was placed at the end of the procedure. No evidence of urine leakage was found postoperatively. Symptomatic success was achieved in 35 (97.2%) of the 36 patients, and imaging-proved success was achieved in 34 (94.4%). The mean follow-up period was 48 months (range 3-89). Our results have confirmed that retroperitoneoscopic peripelvic renal cyst decortication is a safe, feasible, and effective procedure. It offers a favorable minimally invasive treatment option for symptomatic peripelvic renal cysts, although it remains technically challenging.

Laparoscopic Simultaneous Treatment of Peripelvic Renal Cysts and Stones: Case Series

Renal multiple peripelvic cysts are often symptomatic. Obstruction of renal hilum and the collecting system leads to hydronephrosis and could promote formation of stones. Managing both entities at the same time needs a new approach to minimize complications and improve success rates. We report for the first time five cases of symptomatic multiple peripelvic cysts and concomitant kidney stones treated by a laparoscopic approach. Between 2003 and 2007 three men and two women, with a median age of 60 years with peripelvic renal cyst and synchronous kidney stones underwent a laparoscopic ablation of cysts, concomitant pyelolithotomy, and stone removal with a flexible auxiliary cystoscope. Mean cyst size was 45 mm (range 15-70 mm). Mean stone size was 25 mm (range 10-33 mm). The mean operative time was 173 minutes (range 150-235 minutes). There were neither intraoperative complications nor conversions to open surgery. Mean blood lost was less than 100 mL, and mean hospital stay was 3.2 days (range 3-5 days). After removal of ureteral catheter, patients were asymptomatic and without signs of hydronephrosis. Computed tomography after 6 months showed clearance of all cysts and stones without sign of recurrence. Laparoscopic management of urolithiasis should be an alternative choice of treatment in some particular and selected indication. Concomitant symptomatic peripelvic cysts and kidney stones could justify simultaneous laparoscopic management. The procedure is technically challenging but safe and effective, and it avoids a staged treatment.

Laparoscopic Transperitoneal Decortication of a Giant Peripelvic Renal Cyst

Laparoscopic decortication is currently considered the standard treatment of peripelvic renal cysts, in spite of the technical challenge due to the close contiguity with renal hilar structures. However, to date, few small series or single cases of laparoscopic decortication for symptomatic peripelvic cyst have been reported. In this paper, we report the first case of a giant peripelvic cyst (25 x 18 x 9 cm) treated by transperitoneal laparoscopic decortication in a young adult female. Pain relief and hypertension control were obtained early after surgery, and the patient is symptom free at a 30-month follow-up.

MP-06.20: Retroperitoneal laparoscopic approach of symptomatic peripelvic renal cysts

MP-06.20: Retroperitoneal laparoscopic approach of symptomatic peripelvic renal cysts

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.

Laparoscopic ablation of symptomatic peripelvic renal cysts.

We report our experience with laparoscopic ablation of symptomatic peripelvic renal cysts. Two men and two women (mean age 58) with a peripelvic renal cyst associated with ipsilateral flank pain and obstruction were treated by transperitoneal laparoscopic ablation. One patient had an episode of pyelonephritis before detection of the cyst. Cyst size ranged from 4.5 to 6.5 cm (mean 5.5 cm). Dissection of the cyst was intricate because of the close proximity to the renal hilum and the compressed collecting system. Patients were followed with radiologic imaging at 6 and 12 months and once a year thereafter. In all cases, the laparoscopic procedure was successful. The operative time ranged from 120 to 190 minutes (mean 155 minutes), and the mean blood loss was <150 mL. The mean postoperative hospital stay was 2.7 days (range 2-5 days), and the time of convalescence was 14 days. Complications consisted of a subcutaneous hematoma. At a mean follow-up of 23 months, symptoms and collecting system obstruction had resolved in all patients. Although laparoscopic ablation of peripelvic renal cysts is technically challenging, it is a safe and efficacious procedure and offers a favorable minimally invasive alternative for the treatment of symptomatic cysts.

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.

Laparoscopic ablation of peripelvic renal cysts

Recently, laparoscopic surgery has been reported for symptomatic renal cysts. A 60-year-old female was referred to Toyama Medical and Pharmaceutical University Hospital with a chief complaint of general fatigue and left back pain. CT demonstrated bilateral peripelvic renal cysts, and DIP demonstrated left hydronephrosis and a medical shift of the left renal pelvis. Laparoscopic ablation of bilateral peripelvic renal cysts was performed under general anesthesia and a round excision was made in the cyst wall via the peritoneum. After surgery, the left back pain disappeared and CT demonstrated resolution of peripelvic renal cysts. Laparoscopic ablation of peripelvic renal cyst is a highly effective and minimally morbid procedure.

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).

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.