Symptomatic Simple Renal Cysts Research Articles

Symptomatic Simple Renal Cysts Treated with Percutaneous Sclerotherapy: Long-term Results

Background: Simple cysts are the most common lesions in the kidney and symptomatic patients require treatment. This study evaluates the use of single-sitting percutaneous sclerotherapy with needle aspiration under ultrasound (US) guidance in patients suffering from symptomatic simple renal cysts. Materials and Methods: Twenty-four patients suffering from symptomatic simple renal cysts during the period January 2018 to January 2020 underwent needle aspiration followed by sclerotherapy under ultrasound (US) guidance. Sclerotherapy with 30 mg sodium tetradecyl sulfate (STDS) was performed after aspiration of the renal cysts. A total of 28 symptomatic simple renal cysts in 22 patients were included in the study, two patients were lost for follow-up. The follow-up period was 48 months. Results: The diameter of the renal cysts ranged between 5.5 and 8.5 cm (mean: 6.24 ± 1.05 cm), and between 0 and 4 cm (mean: 0.286 ± 0.004 cm) before and after sclerotherapy, respectively (P < 0.001). The average diameter reduction was 92.16% during the follow-up period of 48 months. Flank pain was resolved in all the patients (100%). The procedure was termed “success” with all the patients. The three cysts in which, the reduction of size was <75% were more than 8 cm in initial size, and in one case, it was bilateral renal cysts. In these cases also, the pain was reduced completely and did not require any further treatment. We did not observe any procedure-related complications. Conclusion: Single-sitting needle aspiration with sclerotherapy using STDS under US guidance is an effective and safe method for treating symptomatic simple renal cysts.

Sclerotherapy of a Symptomatic Renal Cyst.

Simple renal cysts are not commonly found in children. They occur in a small percentage of cases, with an incidence of 0.2%-0.5%. These cysts are typically solitary and develop in the renal cortex. Pain, infection, hematuria, hypertension, or obstruction of the collecting system are indications for treatment. When intervention is necessary, there are several ways to reduce cyst volume. In this report, we discuss the pediatric case of a solitary giant renal cyst and its therapeutic approach. We present a symptomatic pediatric renal cyst patient treated with a sclerosing agent. A simple renal cyst is a rare condition in children, and its treatment includes conservative management, percutaneous sclerosing agent injection, and surgical approach. Choosing the appropriate treatment according to the patient's condition and clinical symptoms is essential. We think that sclerotherapy should be the first-line therapy before surgery in symptomatic simple renal cysts.

A case involving laparoscopic decortication of a large simple renal cyst using conventional monopolar device.

Introduction and importanceSimple renal cysts are common in adults, but most of them are asymptomatic. Usually, percutaneous puncture is an initial treatment, but laparoscopic decortication may be effective for recurrent simple renal cyst. Herein, we report a case in which a large symptomatic simple renal cyst was treated with laparoscopic decortication using conventional monopolar device.Case presentationA 34-year-old female visited our hospital with chief complaints of back pain and abdominal fullness. Computed tomography showed a right simple renal cyst (diameter: 140 mm). We performed percutaneous drainage with sclerotherapy, but the cyst recurred a month later. Thus, we carried out laparoscopic decortication. We opened the cyst wall via a retroperitoneal approach and trimmed it using monopolar scissors. The operation time was 124 min. The patient's postoperative course was uneventful, and no complications were observed. Following surgery, the patient was asymptomatic.Clinical discussionIn our case, we performed operation using a conventional monopolar device without sealing devices. It has been reported that the use of sealing devices can make laparoscopic surgery safer and reduce the operation time, but we herein report that laparoscopic decortication with a conventional monopolar device is an effective and safe treatment option for symptomatic simple renal cysts and that more expensive energy sources are not required.ConclusionWe successfully performed laparoscopic decortication of a large symptomatic simple renal cyst. This operation is minimally invasive and safe.

Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts—An innovative ambulatory surgery mode

ObjectiveThis study was designed to evaluate the feasibility, efficacy, and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia. MethodsFrom December 2015 to September 2017, 33 simple renal cyst patients who had surgical indications were enrolled. Under ultrasound guidance, the T10/T11, T11/T12, and T12/L1 paravertebral spaces were identified, and 7–10 mL 0.5% ropivacaine was injected at each segment. Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring. A guidewire was introduced followed by sequential dilation up to 28/30 Fr. The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser, and a pathological examination was performed. ResultsSensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients. None of the patients complained of pain during surgery. No serious complications occurred perioperatively. After the surgery, all patients recovered their lower limb muscle strength quickly, got out of bed, resumed oral feeding, and left the hospital within 24 h of admission. The pathologic diagnosis of all cyst walls was a simple renal cyst. The mean follow-up was 35.8 months. At the end of follow-up, the cyst units were reduced in size by more than 50% compared to the preoperative size, and no patient experienced a recurrence. ConclusionMulti-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible, safe, and effective for the treatment of simple renal cysts in selected patients.

Comparison of Polidocanol Sclerotherapy with Laparoscopic Deroofing in the Management of Pediatric Symptomatic Simple Renal Cysts: A Long-Term Study

Objective: To compare the efficacy and safety of percutaneous polidocanol sclerotherapy and laparoscopic deroofing in the management of pediatric symptomatic simple renal cysts (SRCs). Methods: Forty-six patients with symptomatic SRCs (cyst size ≥4 cm) were treated either with polidocanol sclerotherapy (group A) or by laparoscopic deroofing (group B) between December 2009 and October 2019. The patients were reevaluated at 1, 6, and 12 months and annually thereafter. Results: Twenty-one patients were treated with polidocanol sclerotherapy (group A) and 25 patients with laparoscopic deroofing (group B). The mean follow-up period was 58.7 months (14-107) in group A and 57.2 months (12-118) in group B. Complete regression was seen in 19 (90.5%) and 24 (96%) patients in groups A and B, respectively (p < 0.05). Partial regression was documented in one patient each in group A (4.8%) and B (4%). In one group A patient, a laparoscopic deroofing was performed due to sclerotherapy failure after 27 months. The operation time, postoperative hospital stay, and cost were significantly less in group A than in group B (36.3 ± 8.4 vs 96.9 ± 19.1, 19.7 ± 2.4 vs 56.0 ± 8.6, and ¥8173 ± 1343 vs ¥14,119 ± 2021, respectively; p < 0.05). Conclusion: Polidocanol sclerotherapy and laparoscopic deroofing were found to be equally effective interventions associated with minimal complications for pediatric symptomatic SRCs. We recommend polidocanol sclerotherapy as the first option for children with symptomatic SRCs and laparoscopic deroofing in cases of failed polidocanol sclerotherapy.

Radiologically guided percutaneous aspiration and sclerotherapy of symptomatic simple renal cysts: a systematic review of outcomes.

Simple renal cysts are common benign lesions of the kidney with up to 4% of patients developing symptoms necessitating intervention including pain and haematuria. We conducted a systematic review of the literature to determine the efficacy and safety of aspiration-sclerotherapy of symptomatic simple renal cysts. A systematic review using Cochrane guidelines was conducted on published literature from 1990 to 2020. RCTs, cohort studies and case series meeting the inclusion criteria were reviewed and cumulative analysis of outcomes was performed. A total of 4071 patients from 57 studies underwent aspiration ± sclerotherapy for their simple renal cysts. 87.7% of patients who had aspiration with sclerotherapy demonstrated 'treatment success' with a >50% reduction in cyst size and complete resolution of symptoms. 453 minor, transient complications occurred (11.2%) whilst a major complication rate of less than 0.1% (4 patients) was reported. Pooled analysis of all available current literature demonstrates that aspiration-sclerotherapy is a safe and effective first-line therapy for symptomatic simple renal cysts. Although we are unable to compare those undergoing aspiration alone to aspiration-sclerotherapy, it is evident the use of a sclerosing agent is integral to treatment success; however, the optimum agent, volume, injection frequency, and dwelling time are yet to be defined. Cyst size should be considered when discussing treatment options; however, we conclude it reasonable for aspiration-sclerotherapy to be used in the first instance in all cases of symptomatic simple renal cysts. Furthermore, we propose definitions of treatment outcome measures in order to allow direct comparative analysis across future studies.

The Effectiveness of Ultrasound-Guided Percutaneous Aspiration of Simple Renal Cysts in Hospitals of Aljouf Region, Saudi Arabia

Background: Percutaneous renal cyst aspiration and sclero-therapy are considered as single, a safe and minimally invasive procedure currently practicing by numerous uro-surgeons currently in the treatment of simple symptomatic cysts. Objectives: This study was designed to assess the effectiveness and complications of ultrasound (US) guided percutaneous aspiration of renal cysts with 99% ethanol as sclerosing material in the treatment of simple symptomatic renal cysts. Methodology: This observational prospective study was done among 42 patients who had a total of 47 symptomatic simple renal cysts. It was carried out during the period from 2014 to 2017 in the Outpatient Clinic of MOH. The patients’ age ranged between 23-62 years including male (19) and females (23). An US guided ablation of renal cyst was done under local anesthesia. After that, an equal volume of contrast medium was injected through the needle into the cyst cavity to delineate the cyst wall. The sterile 99% ethanol, with one fourth of total cyst volume was injected into the cyst after complete aspiration of the contrast medium. After that, the ethanol was aspirated, and volume was measured. Results: The complications were minimum including, hematuria in 8 patients (17%), low-grade fever in 7 patients (14.8%) and mild flank pain in 5 (10.6%) patients were observed. During the follow-up after the sclerotherapy, out of 47 cysts, 20 (42.5%) cysts with different sizes showed statistically significant (P < 0.05) complete resolution and not appeared again during the later follow-up sessions. The overall success rate in the current study procedure was 100%. Conclusion: Percutaneous aspiration with a single injection of 99% ethanol sclerotherapy gave a high success rate in the treatment of simple renal cysts with good optimization of sclerosing material and effective aspiration skill of uro-surgeon.

The Effectiveness of Ultrasound-Guided Percutaneous Aspiration of Simple Renal Cysts in Hospitals of Aljouf Region, Saudi Arabia

Background: Percutaneous renal cyst aspiration and sclero-therapy are considered as single, a safe and minimally invasive procedure currently practicing by numerous uro-surgeons currently in the treatment of simple symptomatic cysts. Objectives: This study was designed to assess the effectiveness and complications of ultrasound (US) guided percutaneous aspiration of renal cysts with 99% ethanol as sclerosing material in the treatment of simple symptomatic renal cysts. Methodology: This observational prospective study was done among 42 patients who had a total of 47 symptomatic simple renal cysts. It was carried out during the period from 2014 to 2017 in the Outpatient Clinic of MOH. The patients’ age ranged between 23-62 years including male (19) and females (23). An US guided ablation of renal cyst was done under local anesthesia. After that, an equal volume of contrast medium was injected through the needle into the cyst cavity to delineate the cyst wall. The sterile 99% ethanol, with one fourth of total cyst volume was injected into the cyst after complete aspiration of the contrast medium. After that, the ethanol was aspirated, and volume was measured. Results: The complications were minimum including, hematuria in 8 patients (17%), low-grade fever in 7 patients (14.8%) and mild flank pain in 5 (10.6%) patients were observed. During the follow-up after the sclerotherapy, out of 47 cysts, 20 (42.5%) cysts with different sizes showed statistically significant (P < 0.05) complete resolution and not appeared again during the later follow-up sessions. The overall success rate in the current study procedure was 100%. Conclusion: Percutaneous aspiration with a single injection of 99% ethanol sclerotherapy gave a high success rate in the treatment of simple renal cysts with good optimization of sclerosing material and effective aspiration skill of uro-surgeon.

A Painless and Time-Saving Modified Technique for Simple Renal Cyst Treatment with Single-session Ethanol Sclerotherapy

Percutaneous puncture ethanol sclerotherapy is a simple, effective, minimally invasive, and inexpensive procedure to manage symptomatic simple renal cysts. We modified specific technical aspects to balance certain potential intraprocedural factors for ensuring minimal procedural pain and duration as well as maximal clinical therapeutic effects and evaluated the safety and efficacy of this modified technique. A total of 84 eligible patients underwent computed tomography-guided single-session ethanol sclerotherapy using the conventional (group A) or modified (group B) technique. In group B, the puncture route was modified from tansparenchymal to direct for reducing renal injury, and preinjection of low-dose intracystic lidocaine was used to control distending pain caused by ethanol injections; therefore, greater ethanol volumes could be injected for improving the resistance and contact of ethanol with the cyst wall, precluding the need for patient repositioning multiple times to decrease procedural duration. Visual analog scale score for pain and procedural time were significantly higher in group A than in group B. The complication rate was slightly higher in group A than in group B, but the success rate was comparable between the two groups. These results suggest that the modified technique is painless, time-saving, and injury-reducing and can thus improve medical care.

Laparoscopic or Robotic Deroofing Guided by Indocyanine Green Fluorescence and Perirenal Fat Tissue Wadding Technique of Pediatric Simple Renal Cysts.

Purpose: To present the outcomes of the laparoscopic and robotic treatment of pediatric simple renal cysts with two novel modifications: the indocyanine green (ICG) fluorescence and the perirenal fat tissue wadding technique. Methods: Between 2012 and 2019, 13 patients with solitary renal cysts were treated through minimally invasive approach. Preoperative work-up included ultrasonography and computed tomography or magnetic resonance. A cyst deroofing was performed in all cases. In the last 3 cases, the ICG fluorescence technique enabled a clear identification and safe puncture of the cyst dome. Five cysts were filled with perirenal fat tissue after deroofing. Results: Thirteen patients (9 boys) were treated through laparoscopic (6 patients), retroperitoneoscopic (3 patients), or robotic approach (4 patients). Median age was 8 years (5-15 years). The median cyst size was 70 mm (42-160 mm). Eight cysts were located in the right kidney. All cysts were progressive and symptomatic. Thirteen cysts (100%) were graded as type II according to the Bosniak classification. No conversion was recorded. The median operative time for laparoscopy was 50 minutes (35-90 minutes) and 85 minutes for robotics (65-120 minutes) including surgical and docking time. No intraoperative complications occurred. The median hospital stay was 2 days (36-96 hours). No residual liquid was detected on follow-up after deroofing and fat tissue wadding technique. Conclusions: Cyst deroofing is an effective and durable treatment for symptomatic simple renal cysts. Robotics enables excellent tissue dissection and ergonomics. The perirenal fat tissue wadding of the cyst seems to reduce the recurrence rate. The ICG fluorescence technique allows for better identification of the cyst and safer surgical procedure.

Laparoscopic treatment of symptomatic simple renal cysts in children: single-center experience.

Simple renal cysts, although common in adults, are rare in children. They are usually discovered incidentally in the course of the study of other urinary tract symptoms, although they are not always asymptomatic. Renal cysts can be classified as being either simple or complex. The purpose of this review is to present our case series of simple symptomatic renal cysts treated with laparoscopy. Nineteen patients with symptomatic renal cysts (6 to 13.5 cm) were referred to our institution between January 2006 and January 2017. They comprised 12 (40.5%) females and seven (59.5%) males, aged 8 to 15, with a mean age of 12.2 years. Of these patients, nine had previously been treated unsuccessfully by ultrasound-guided aspiration/alcoholization with 95%-ethanol, between 9 and 13 months prior to the laparoscopy. Five patients had undergone one treatment and four had undergone two treatments. All of the patients were treated by laparoscopic threetrocar deroofing. The cysts were opened and the wall excised using scissors and a monopolar hook. In most cases, to better handle the edges of the cyst and obtain a better grip, a needle was used to aspirate a small amount of fluid (used for cytological examination). The wall of the cyst was excised, the cyst edges were sealed, and the perirenal fat was placed on the bottom of the cyst (wadding technique). The mean operating time was 95 minutes (range 50- 150). The postoperative course was uneventful for all of the patients. The hospital stay ranged from one to three days. All of the patients were asymptomatic following the treatment. At a mean follow-up time of 3.6 years, none of the patients had experienced a recurrence. Renal function, as assessed by a MAG3 renal scintigraphy scan, was well-preserved in all of the patients, and all of them undergo an annual ultrasound scan.

The management of symptomatic simple renal cysts in children

Abstract Renal cysts are being increasingly diagnosed in children due to the increasing use of ultrasound scanning (USS). Most are asymptomatic, but they may present with flank pain, haematuria, palpable mass or even urinary tract infections or urosepsis. There is a wide range of management options for symptomatic cysts, the choice of which depends on patient factors as well as surgeons' preference. In this case series, we present our experience in the management of five cases of symptomatic renal cysts which have been treated in varying ways, ranging from minimally invasive procedures to drain and sclerose the cysts, to more invasive procedures to excise and deroof the cysts.

Efficacy of Laparoscopic retroperitoneal deroofing of simple renal cyst in comparison with open surgery

Objective: to evaluate efficacy and safety of laparoscopic retroperitoneal deroofing in comparison with open deroofed cases. Patients and methods: over period of 3 years , 11 patients with symptomatic simple renal cysts , underwent laparoscopic retroperitoneal deroofing and another 15 patients with same symptoms, underwent open deroofing.Results: Insignificant difference between both procedures regarding operative time, blood loss, recurrence rate, with better results for laparoscopic retroperitoneal deroofing regarding hospital staying, convalescence period and wound complication.Conclusion: Laparoscopic retroperitoneal deroofing of simple renal cyst is safe and effective procedure with minimal complication in comparing with open one.

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.

Ultrasound-guided percutaneous sclerotherapy of simple renal cysts with n-butyl cyanoacrylate and iodized oil mixture as an outpatient procedure.

Objective:The aim of this study was to evaluate the efficacy and safety of ultrasound guided percutaneous sclerotherapy of symptomatic simple renal cysts with n-butyl cyanoacrylate (NBCA) and iodized oil mixture as an outpatient single session procedure.Materials and Methods:A total of ninety two patients with 100 symptomatic simple renal cysts (larger than 5 cm) were treated by ultrasound (US)-guided percutaneous aspiration and injection of NBCA and iodized oil mixture. The patients (68 men and 24 women, mean age, 42.4 ± 10.5 years) were treated with as out-patients. The volume of the treated cysts was calculated with periodic noncontrast enhanced CT examinations 3, 6 and 9, months after the procedure. The procedure was considered successful at follow-up CT when there was total ablation or greater than 80% reduction of size with resolution of symptoms, respectively. Failure was defined as less than 80% reduction and/or persistent symptoms.Results:The sclerotherapy was technically successful in all patients. The diameter of the cysts ranged between 5.5 and 13.5 cm (mean, 8.8 ± 1.4 cm), and 1.5 and 3.8 cm (mean, 2.1 ± 0.4 cm) before and after sclerotherapy, respectively (P < 0.001). Average diameter reduction was 83.7% during the follow-up period. The mean follow- up lasted 7.1 months (3–11 months). Flank pain resolved in 86 of 92 symptomatic patients (93.48%). In six patients, the symptoms decreased slightly. The procedure was successful in 98 of 100 cysts (98%), demonstrated by follow-up CT. The only two failed cyst was larger than 10 cm in diameter and don’t required any further treatment. We did not observe any procedure related complications.Conclusion:Ultrasound guided percutaneous sclerotherapy with NBCA and iodized oil mixture for management of symptomatic simple renal cysts was found to be a real time, effective, safe, well tolerated, alternative and simple technique that can be carried out by urologists as an outpatient procedure.

Comparison between Retroperitoneal and Transperitoneal Approaches in the Laparoscopic Treatment of Bosniak Type I Renal Cysts: A Retrospective Study.

We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decor­tication of simple renal cysts with respect to safety, postoperative pain, and clinical results. The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and phys­ical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creati­nine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal com­puted tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain. The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min., and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P < .05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient. We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain.

Ureteroscopic management of asymptomatic and symptomatic simple parapelvic renal cysts.

BackgroundTo investigate feasibility and safety of treating simple parapelvic renal cysts using flexible ureteroscopy with the Holmium laser.MethodsBetween February 2010 and July 2013, a total of 21 patients, aging from 29 to 71 (49.00 ± 13.23), were diagnosed with parapelvic renal cysts by ultrasonography in combination with contrast-enhanced computer tomography (CT) and intravenous urography (IVU) in the Department of Urology Surgery, People’s Hospital of the Zhejiang province. Fifteen patients were asymptomatic and 6 patients were symptomatic with flank pain. All patients underwent drainage of the cysts using flexible ureteroscopy with Holmium laser. Patients were followed up 1, 3 and 12 months after the operation.ResultsThe intervention was successful in 20 patients and failed in 1 patient who, subsequently successfully underwent a laparoscopic cyst removal. There were no intra-operative and post-operative complications reported. The mean operation time was 27 min (range: 15 to 45 min). The mean hospital stay was 2.6 days (range: 1 to 5 days). Twenty patients were followed up until 15 months after surgery. After such ureteroscopic management, there were no renal cysts detected in 7 patients (35 %) and a reduction in size of the renal cysts was found in 13 patients (65 %). Flank pain subsided in all 6 (100 %) previously symptomatic patients.ConclusionsFlexible ureteroscopy with the Holmium laser may be a feasible and effective treatment option in selected patients with simple parapelvic renal cysts. Further prospective randomized studies that compare the procedure to laparoscopic treatments are needed.

Comparison of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts.

The aim of the study was to compare the efficacy and cost-effectiveness of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts. Between March 2010 and December 2012, patients with simple renal cysts presenting with pressure and pain symptoms were divided into two groups. In Group 1 following local anesthetic administration, single session percutaneous aspiration with 95% ethanol sclerotherapy (n=38) and in Group 2 transperitoneal laparoscopic de-roofing under general anesthesia (n=42) were performed. The data were evaluated retrospectively and demographic characteristics, duration of operation and hospitalization, complication rates, cost effectiveness, radiological and symptomatic success rates at six month- follow-up were compared between the two groups. The mean age and gender of the patients, cyst diamater, side and localization of the cyst and indications for intervention were similar in two groups. The median course of treatment and hospitalization were signifcantly decreased in Group 1 (respectively 33 min versus 59 min and 6 hours versus 24 hours, p<0.001). As complications in Group 1 fever in two patients (5.3%) and in Group 2 bleeding requiring transfusion in one patient (2.4%) were observed (p=0.495). Total cost was calculated as $ 131.7 in Group 1 and $ 729.8 in Group 2. After the sixth month follow-up control radiological success rates were found to be signifcantly higher in Group 2, while symptomatic success rate is similar in both groups (63.2% versus 95.2%, p<0.001; 94.7% versus 97.6%, p=0.498, respectively). Single-session percutaneous aspiration with alcohol sclerotherapy and laparoscopic de-roofing are safe and effective methods in the treatment of symptomatic simple renal cysts. While radiological recurrence rate was higher in single session percutaneous aspiration with alcohol sclerotherapy, however similar symptomatic recurrence rates were seen with laparoscopy. Therefore single session percutaneous aspiration combined with alcohol sclerotherapy seems to be an important option in the treatment of simple renal cysts when considering the duration of the operation, hospitalization and total costs of the process.

Management of Renal Cysts

Background and Objectives:Renal cysts have a high prevalence in the general population, and their estimated incidence increases with age. Renal cyst aspiration (usually with sclerotherapy) or open/laparoscopic decortication is a generally effective and safe method in the treatment of symptomatic simple renal cysts. The success rates of laparoscopic decortication and percutaneous aspiration-sclerotherapy were compared to assist in the decision making for the procedure.Methods:A total of 184 patients with symptomatic simple renal cysts were treated with either laparoscopic decortication in 149 cases or percutaneous aspiration-sclerotherapy in 35 cases. The follow-up period was approximately 35 months, and the symptomatic and radiologic success rates of the 2 techniques were compared retrospectively.Results:Laparoscopic decortication was found to have high success rates, a low recurrence rate, and minimal morbidity. Percutaneous aspiration-sclerotherapy is an outpatient procedure with a minimally higher recurrence rate.Conclusion:When a symptomatic cyst is encountered and treatment of the cyst is indicated, laparoscopic decortication is a more efficient method that offers better results than percutaneous aspiration-sclerotherapy.

Ethanolamine oleate vs. absolute ethanol as sclerosing agents for treating symptomatic simple renal cysts

ObjectivesTo compare the efficacy and safety of ethanolamine oleate (EO) as a sclerosing agent, vs. absolute ethanol (AE), in the treatment of symptomatic simple renal cysts. Patients and methodsBetween November 2009 and October 2012, 46 patients were prospectively randomised into two groups. All patients presented with a simple renal cyst underwent ultrasonographic aspiration and injection of a sclerosing agent. In group 1, 25 patients had the cyst injected with EO, and in group 2, 21 were treated with AE. One injection was used in cysts of <200mL and two injections were used in larger cysts. Complete and partial success were defined as complete cyst ablation or a >50% reduction in cyst volume with symptomatic relief, respectively. Patients were followed up using semi-annual ultrasonography and computed tomography for 2years. ResultsSclerotherapy was technically successful in all patients. There was no significant difference in cyst volume between the groups. After ≈2 years of follow-up there was complete symptomatic relief in both groups, and the overall radiological success rate was 100% of both groups, at 79% complete and 21% partial in group 1, and 83% complete and 17% partial in group 2. The frequency of transient complications in the form of microscopic haematuria was 7% and 13%, and of low-grade fever in 4% and 10% in groups 1 and 2, respectively. ConclusionEO can replace AE as a sclerosing agent for symptomatic simple renal cysts, as it has comparable efficacy with higher safety and tolerance.