Renal Cyst Puncture Research Articles

A surgical case of high-grade urothelial carcinoma of the renal pelvis complicated with giant hydronephrosis, giving rise to diagnostic difficulties on a cytological examination

BackgroundWe report a surgical case of urothelial carcinoma of the renal pelvis, resulting in diagnostic difficulties on cytological examination.Case presentationA man in his late 70s underwent nephrectomy for giant hydronephrosis and renal cysts after nephrostomy and renal cyst puncture and drainage. On all cytological examinations performed before surgery, including nephrostomy urine, renal cyst fluid, catheterized bladder urine, and bladder washings, we were unable to make any conclusive diagnosis of malignancy. The pathological diagnosis of the surgical specimen concluded that this was a case of high-grade urothelial carcinoma of the renal pelvis with focal squamous differentiation (pT4). Liver and lung metastases were identified 3 months after surgery, and the patient died 2 months later.ConclusionIt was very difficult to make a conclusive diagnosis using cytological specimens because of the presence of a small number of atypical cells with severe degenerative changes. Since clinicians cannot predict the potential for malignancy on preoperative imaging findings, it is critical to consider the difficulties in clinically making a correct diagnosis of urothelial carcinoma of the upper urinary tract, especially in cases complicated with giant hydronephrosis.

The efficacy and safety of single flexible ureteroscope vs. flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage

Objective To evaluate the efficacy and safety of single flexible ureteroscope vs. flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage. Methods Retrospective analysis of case data of 64 patients with endogenous renal cysts admitted from January 2015 to December 2017. All the patients undrwent contrast-enhanced CT, urinary tract imaging, ultrasound B to confirm bosniak classification Ⅰ and Ⅱ renal cyst. The patients (38 males, 26 females)were divided into single flexible ureteroscope group [group A, 32 cases of patients, average age (54.2±6.6) years, unilateral or bilateral cystic patients: 19 cases/ 13cases, simple cyst of kidney or polycystic kidney: 24 cases/8 cases, average maximum diameter of the renal cyst (5.4±1.3)cm, combined with renal calculus: 8 cases, combined with hydronephrosis: 7 cases, 1 case who had the history of laparoscopic renal cyst decapitation, 1 case who had the history of percutaneous renal cyst puncture] and flexible ureteroscope group combined with intraoperative ultrasonography guided [group B, 32 cases of patients, average age (52.3±9.3) years, unilateral or bilateral cystic patients: 21 cases/11 cases, simple cyst of kidney or polycystic kidney: 25 cases/7 cases. Average maximum diameter of the renal cyst (5.3±1.2)cm, combined with renal calculus: 9 cases, combined with hydronephrosis: 8 cases, 2 case who had the history of laparoscopic renal cyst decapitation, 1 case who had the history of percutaneous renal cyst puncture]. The double J stent was placed two weeks before the surgery into the body of patients. During the operation, the surgical procedure were used by the electronic flexible ureteroscope and holmium laser (0.8 J, 20 Hz), combined with ultrasound B in the monitoring, to find the suitable incision position. It would be defined as the successful result if we could put the head of flexible ureteroscope into the inside of renal cyst and see the image of mist in the screen of ultrasound B. According to the standard, the result of operation wound be defined compared to before operation (success: shrink more than 80% or maximum diameter was smaller than 1 cm; improvement: shrink about 50%-79%; ordinary result: shrink about 30%-49%; failure: shrink smaller than 30%). Effective rate=(success cases+ improvement cases)/total cases. We compared the differences of two groups in the time, efficacy, safety and complication of surgery. Results Compared the results of single flexible ureteroscope groups vs flexible ureteroscope group combined with intraoperative ultrasonography guided in the success cases of surgery, after 8-30 months following-up, total operative complication rate was [8 cases(25%)vs. 1 case(3.1%)], success rate of operation in 6 month later [(20 cases(62.5%) vs. 28 cases(87.5%)]. Flexible ureteroscope group combined with intraoperative ultrasonography guided had advantages statistically (P 0.05). Conclusions Flexible ureteroscope combined with intraoperative ultrasonography guided can help the urologist can improve the success rate of surgery and reduce the chance of surgical injury intraoperatively. Key words: Flexible ureteroscope; Ultrasonography guided; Renal cyst; Endogenous

Methylene Blue Injection via Percutaneous Renal Cyst Puncture Used in Flexible Ureteroscope for Treatment of Parapelvic Cysts: A Modified Method for Easily Locating Cystic Wall

ObjectiveTo describe a modified technique for easily locating cystic wall during flexible ureteroscopic surgery for treatment of parapelvic renal cysts. MethodsNineteen patients with symptomatic/asymptomatic parapelvic renal cyst were treated with modified or conventional flexible ureteroscopic surgery between February 2015 and March 2017, and the differences of the 2 techniques were compared. The detailed surgical procedures and results, postoperative complications, and patients’ follow-ups were evaluated. ResultsAll the patients received endoscopic management by flexible ureteroscope successfully, without requiring another complicated surgery. The cysts were seen clearly in 9 patients with modified method. Two of ten patients who underwent conventional ureteroscopic surgery changed to the modified surgery intra-operatively since it was difficult to identify the cyst. The total time of search and incision of cysts was 24.2 ± 6.2 minutes and 17.7 ± 2.5 minutes for conventional and modified technique respectively (P = .01), of which 11.4 ± 4.8 minutes and 5.1 ± 1.1 minutes to search the cysts, respectively (P = .002), and the mean time of the procedure of puncture was 8 ± 2.3 minutes. Duration of pure incising the cystic wall was 12.8 ± 3.3 minutes and 12.6 ± 2.5 minutes for patients who underwent conventional and modified technique, respectively (P = .859). All patients acquired relief from the presentation of flank discomfort after surgery. All of the patients were followed-up over 12 months and no serious complications and recurrence was observed. ConclusionThe modified technique can decrease time of searching the renal cyst and decrease the total time in flexible ureteroscopic treatment of parapelvic cysts. The limitations of our study were also observed and further studies are needed.

Ultraschall-gezielte Nierenzystenpunktion: Bedeutung für Diagnostik und Therapie*

Renal cyst puncture under ultrasonic guidance has proved an excellent and safe method in the differential diagnosis of cystic renal masses. The use of ultrasound in the follow-up of patients with renal cyst puncture is mandatory for evaluation of complications and results. The therapeutic success of renal cyst puncture is poor and estimated at about 25%. New percutaneous techniques with resection of the cystic wall lead us to expect much better results than with open surgical management.

Ethanolamine Sclerotherapy of a Renal Cyst

We report the effective use of 5% ethanolamine oleate to sclerose a large simple renal cyst. The comparative advantages of ethanolamine versus other sclerosants are discussed in terms of adverse effects, availability and convenience. Guidelines to optimize sclerotherapy with ethanolamine are provided.

Significance of simple renal cysts and percutaneous cyst puncture on renal function.

Renal function was investigated in 17 patients with simple renal cysts. Single kidney glomerular filtration rate was estimated by gamma camera renography with 99mTc-DTPA before, 5 days and 6 months after percutaneous puncture and evacuation of the cysts. Prior to the puncture and evacuation, the only negative effects on renal function noted were signs of moderate obstruction of the renal outflow in 2 patients. Percutaneous puncture with evacuation of the cystic fluid did not change the renal function significantly. It was concluded that simple renal cysts do not have any functional consequences nor does percutaneous puncture and evacuation of the cysts.

Role of Fibrin Glue in Percutaneous Treatment of Renal Cysts

Since January 1988, 18 male and 9 female patients aged 33 to 66 years were submitted to percutaneous ultrasound-guided needle puncture and aspiration of renal cysts. Thereafter, 11 patients were treated with librin glue, 5 patients with alcohol, and 11 patients with alcohol and then fibrin glue. Followup ranged from 6 to 24 months. Fibrin glue after sclerosing treatment with alcohol gave the best results, with complete responses in 45% of cases, and partial response in the remaining patients.

Guided Cyst Puncture and Aspiration

With the widespread acceptance of ultrasonography and computed tomography for the evaluation of renal masses, the role of guided renal cyst puncture in the evaluation of a suspected renal cyst has undergone revision in recent years. In this article, the authors review the technique, interpretation, and complications of diagnostic cyst puncture and attempt to define its current diagnostic and therapeutic indications.

Computed tomography of internally calcified renal cysts.

Three benign renal cysts containing nonperipheral calcifications on CT are presented. Renal cyst puncture and cytologic examination of the aspirate confirmed their benign nature. Calcification, either peripheral or within the mass, may occur in benign or malignant cystic lesions of the kidney. The demonstration of calcification is a definite indication for cyst puncture to avoid unnecessary surgery or overlooking a possible malignancy.

Ultrasound controlled puncture of renal cysts: biochemical and radiological findings (author's transl)

Ultrasonographically-guided renal cyst puncture was done in 128 patients on outpatient basis. Cortical renal cysts were seen in both male and female patients in an equal ratio. Mean age was 59.6 years. Complication rate of percutaneous puncture was low. Only twice transient haematuria was observed, needing no treatment. Aspirated fluids were examined cytologically and biochemically. None of the aspirated specimens showed malignant cells. Biochemically lactate dehydrogenase activity and concentrations of total protein, cholesterol, triglycerides, potassium and creatinine were determined. Potassium and creatinine determination were found to be valuable in distinguishing between cystic-like lesions containing secondary urine (like caliceal cysts, hydronephrosis, urinoma) and those containing primary urine (like cortical renal cysts). Thus measurement of potassium and creatinine in aspirated fluids may be helpful in determining the need for open exploratory surgery. In cases where cystic lesions produce urographically visible defects of the pelvic system, a dilatation of this area after evacuation of the cyst can be demonstrated via intravenous urography.

Chiba needle in renal puncture guided by real-time ultrasound

A technique for renal cyst and renal pelvic puncture is presented using the Chiba needle guided by real-time ultrasound. Our experience in 10 cases is recorded. The advantages of real-time ultrasound guidance are described, and the value of the technique is illustrated. There were no complications in this small series.

Ultrasound Followup of Renal Cyst Puncture

The place of ultrasound and cyst puncture in the evaluation of renal masses is reviewed. Complications of cyst puncture, although rare, do occur. A review of 16 cases of renal cyst puncture revealed only 2 minor complications: in 1 case a pericystic hemorrhage occurred and in I case an intracystic hemorrhage was detected. Both complications were asymptomatic and detected by ultrasound. Ultrasound has proved to be an excellent means of followup for renal cyst puncture.

Percutaneous puncture of renal cysts for diagnostic and therapeutic purposes (author's transl)

Percutaneous needle puncture of space-occupying lesions is an innocuous procedure in the differential diagnosis of renal masses. In conjunction with intravenous urography, ultrasonography and CT-scan it is a method of considerable diagnostic value, which will lead to a nearly complete accurate diagnosis. In this study we will report our experiences with diagnostic and therapeutic puncture of renal cysts. The instillation of Lipiodol has been given up, since a follow-up study became impossible due to radiological problems. The diagnostic procedure to differentiate expanding lesions of the kidney and the technique of percutaneous needle puncture are described as well as indications for surgical exploration.

Ultrasonic real-time guidance for percutaneous puncture.

Real-time scanning was applied to the sonically guided puncture technique. A special puncture attachment connected to the ultrasound sector scanner was developed for this purpose. A puncture needle is introduced into the scanning plane through the canal in the attachment. Excellent real-time images of both the target lesion and the needle can be clearly seen on the oscilloscope during the puncture procedure. Puncture not only for cystic structures but also for solid masses can be made easily and safely by this new technique. Successful applications of the technique have been carried out for renal cyst puncture, percutaneous antegrade pyelography, percutaneous nephrostomy, percutaneous renal biopsy, and perineal prostatic biopsy.

Diagnostic Renal Cyst Puncture and Percutaneous Nephrostomy: Review and Commentary

Diagnostic Renal Cyst Puncture and Percutaneous Nephrostomy: Review and Commentary

Diagnostic Renal Cyst Puncture and Percutaneous Nephrostomy

Diagnostic Renal Cyst Puncture and Percutaneous Nephrostomy

Evaluation of Perihilar and Central Renal Masses Using the Chiba Needle

The Chiba needle was used to puncture 14 central renal masses believed to be cysts. Of these masses 13 were cysts and 1 was a peripelvic liposarcoma. Arteriography was not done before puncture. No complications occurred when these central masses surrounded by parenchyma or adjacent to hilar structures were punctured. Renal cyst puncture and cystography using the Chiba needle are safe methods for optimal diagnosis of central and peripelvic cysts.

Renal Cyst Puncture: Utilization of Pediatric Guide Wire Technique and Upright Radiographic Changers

After puncture of a renal cyst with a polytetrafluoroethylene needle a pediatric 0.021-inch guide wire is inserted through a polytetrafluoroethylene sheath needle. The sheath is then advanced over the wire. The technique is controlled by fluoroscopy or performed under ultrasonography. Aspiration of the contrast material is performed, and then air and diatrizoate meglumine and diatrizoate sodium are injected to outline the borders of the cyst. The patient is then taken to an upright and lateral radiographic changer for routine radiography in the upright and decubitus positions.

Morphologic sequelae to contrast medium deposits in the kidney. An experimental investigation in the rabbit.

Various doses of Pantopaque and Vascoray were injected percutaneously into the kidneys in 17 rabbits. Histologic examination of the kidneys at different time intervals following the injection demonstrated only slight injury to the renal parenchyma which could be related to the contrast media. Therefore, it seems reasonable to assume that the risk of causing renal damage by using Pantopaque in connection with renal cyst puncture is small.

Residual pantopaque® in renal cysts: An addition to the differential diagnosis of intra-abdominal heavy-metal densities

Single or multiple heave-metal densities seen on abdominal radiographs give rise to several diagnostic possibilities. These include pills or foreign bodies in the gastrointestinal tract, barium in colonic diverticula, and bullets or shrapnel. This communication describes two patients in whom heave-metal densities observed on abdominal radiographs were caused by residual Pantopaque from prior renal cyst puncture.