Treatment Of Simple Renal Cysts Research Articles

Robot-assisted treatment of simple renal cysts

BACKGROUND: The gold standard in the surgical treatment of simple renal cysts is laparoscopic cyst fenestration. However, laparoscopic procedures have disadvantages which include poor ergonomics of the instruments hindering surgeon's work in children's small abdomen. Robot-assisted surgery has the potential to make surgeon's work easier and to improve surgical outcomes in patients with kidney cysts for the instruments have seven degrees of freedom, hand tremor is filtered. It also promotes comfortable console positioning for the surgeon, and three-dimensional wide-angle imaging of the surgical field. AIM: To present the first experience of applying robot-assisted surgery for fenestration (decortication) of the outer portion of the cyst and argon-plasma coagulation of its inner lining. METHODS: The author's present retrospective data of all patients with simple renal cysts operated on with robot-assisted approach at the Irkutsk State Regional Children's Clinical Hospital. The diagnosis was put after ultrasound examination of kidneys and after computed tomography with intravenous contrast agent. Surgery was performed using a new model of the Versius robotic system manufactured by Cambridge Medical Robotics (UK). RESULTS: Patients' mean age at the time of surgery was (13±5.3) years (median 15 [11; 16] years), mean weight — (46.7±17.2) kg (median 54 [40.5; 56.5] kg), smallest body weight — 27 kg, size of cysts — (1.8±2.4) cm (median 0.4 [0.4; 2.5] cm). Cystic formations in all patients were located on the left: in the upper pole in 2 patients, in the lower pole in 1 patient. During the surgical intervention, there were no complications in the form of bleeding from the kidney parenchyma or damage to neighbouring organs. Histological analysis revealed that the lining of the cyst wall contained transitional epithelium without signs of malignancy. Duration of surgery was (136.7±72.2) min (median 95 [95; 157] min), duration of patients' stay in the intensive care unit — (19.9±2.5) hours (median21.3 [19.1; 21.4] hours), duration of hospital stay — (9.3±2.3) days (median 8 [8; 10] days). Ultrasound examination made in 1, 3 and 6 months after the surgery revealed no signs of disease recurrence in the form of residual accumulation of fluid associated with kidney parenchyma. CONCLUSION: The experience described in the article is encouraging and confirms the reasonability and safety of robot-assisted procedures in pediatric urology.

Percutaneous treatment of simple renal cysts with 24-h-interval ethanol sclerotherapy.

To investigate the efficacy of 24-h interval multiple-session ethanol sclerotherapy for the treatment of simple renal cysts. The study sample included 58 patients (mean age, 65.37 ± 11.95 years). We included 76 simple renal cysts that were treated with percutaneous aspiration with a minimum of two sessions of 95% ethanol sclerotherapy in a 24-h interval between sessions. Patients were evaluated at 1, 3, and 6 months after the intervention for the efficacy of the treatment. Treatment success was defined as a complete regression of a cyst or a > 50% reduction in its volume, with no recurrence of symptoms. The mean preprocedural cyst size was 72.98 ± 25.14 mm, and the mean preprocedural cyst volume was 205.76 ± 244.15 mL. The mean volume of ethanol used in the first sclerotherapy session was 62.76 ± 30.71 mL. The mean fluid accumulation in the cysts at the end of the first 24-h interval was 4.66 ± 7.13 mL. The mean quantity of ethanol used in the second sclerotherapy session was 26.48 ± 22.2 mL. A third sclerotherapy session was required in only 10 (13.2%) of the cysts. The mean follow-up period was 52.84 ± 37.83 months. The rate of complete regression was 97.4% for the whole sample at the end of the follow-up. Ethanol ablation with 24-h intervals is a safe and effective treatment option in the minimally invasive percutaneous treatment of simple renal cysts.

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.

A controlled clinical study of a two-trocar mini-laparoscopic technique versus the standard laparoscopic technique in treatment of adult renal cysts.

IntroductionLaparoscopic renal cyst decortication is currently the best choice for the treatment of simple renal cysts and is widely used in clinical practiceAimTo investigate the safety and clinical efficacy of two-trocar mini-laparoscopic decortication of adult renal cysts.Material and methodsA total of 90 patients were enrolled in the study and randomly divided into two groups: a two-trocar mini-laparoscopic treatment group (M group) and a three-trocar standard laparoscopic treatment group (S group), with 45 patients in each group.ResultsThe average length of hospital stay was shorter, and the demand for postoperative analgesics was less in the M group than in the S group (p < 0.05). The proportion of “very satisfied” patients in the patient physical recovery satisfaction survey was significantly higher in the M group than in the S group (p < 0.05). Of the 45 patients in the M group, 40 successfully underwent surgery. In 3 patients, the two-trocar procedure was converted to a three-trocar procedure due to difficulty in separating perirenal adhesion for visualization. Mini-laparoscopic surgery was converted to classic laparoscopic surgery in 2 patients. In the S group, 44 patients successfully underwent the renal cyst decortication procedure. One patient underwent partial renal resection due to an intraoperative diagnosis of multilocular cystic renal cell carcinoma. Postoperative urine leakage was reported in 3 patients in the M group and two in the S group.ConclusionsTwo-trocar mini-laparoscopic treatment of renal cysts is as safe and effective as traditional laparoscopy but is associated with less cosmetic damage, leading to a better physical appearance.

Sustained volume decreases in simple renal cysts after sclerotherapy using NBCA with or without hydrodissection

The present study aimed to determine the effectiveness of sclerotherapy using NBCA (Histoacryl Blue®; B. Braun, Melgungen, Germany), with or without hydrodissection, for the treatment of simple renal cysts. Materials and Methods: Patients who presented to an interventional radiology clinic for the diagnosis of symptomatic renal cysts which had previously been identified at an outpatient clinic were selected for inclusion in this study. A total of 28 patients were randomly divided into 2 groups, based on whether or not they underwent hydrodissection along with ultrasound-guided NBCA-based sclerotherapy. Sonographs were performed at 0, 7, and 180 days post-procedure to record the residual volume of the renal cysts and to determine the efficacy of the procedure. Results: A total of 32 cysts in 28 patients were treated with sclerotherapy, 18 (64%) females and 10 (36%) males. The average age of the patients was 61.8 years (range: 33–89 years). All patients reported an improvement in symptoms associated with the existing renal cysts at 7 and 180 days post-procedure, and at 7 days post-procedure a statistically significant reduction in cyst volume was observed (all patients: 96.8%; group A: 96%; group B: 97.6%). The reduced cyst volume was still observed 180 days post-procedure (all patients: 98.6%; group A: 98.2%; group B: 98.9%). There was no significant difference between the two treatment groups. Conclusion: There is a significant and persistent reduction in the volume of renal cysts, in addition to an improvement of the associated symptoms, after treatment with NBCA-based sclerotherapy, with or without hydrodissection.

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.

How safe and effective is laparoscopic decortication of simple renal cysts in elderly patients?

Objective: To investigate the assessment of feasibility and safety of laparoscopic decortication of simple renal cysts in elderly patients.Methods: The data of 114 patients who underwent laparoscopic decortication for simple renal cyst between October 2011 and May 2019 were retrospectively evaluated. Patients’ age, gender and ASA scores; operation time; cyst size and location; complications; hospital stays and success rates of operations were recorded.Results: The mean age of the patients were 73.8 ± 8.2 years. Forty-eight (42.1%) of the patients were female and 66 (57.9%) were male. Cysts were localized on the right side in 61 (53.5%) patients and on the left side in 53 (46.5%) patients; and mean cyst size was 72.83 ± 31.13 mm. Also, they were localized on the anterior in 88 (77.2%) patients and on the posterior of the kidney in 26 (22.8%) patients. Preoperative ASA score distributions were ASA-I in 12 patients (10.5%), ASA-II in 31 patients (27.2%), ASA-III in 68 patients (59.7%), and ASA-IV in 3 patients (2.6%). Mean operative time was 41.4 ± 5.6 min. Clavien grade 1 complications were observed in 5 (10.4%) patients. Median hospitalization time was 1 day. No recurrence was occurred in any patient in the postoperative period.Conclusions: Although laparoscopic surgery has some risks and complications for elderly patients, laparoscopic decortication can be applied safely and effectively in treatment of simple renal cyst in that patient population.

Using Polidocanol in Treatment of Simple Renal Cyst

The aim of this study was to assess the efficacy of polidocanol in patients with simple renal cysts who were not eligible for surgery due to comorbidities. Twenty-nine patients with Bosniak type 1 or 2 were assessed retrospectively. All of the cysts were exophytic. All of the patients were injected a maximum 20 mL 3% polidocanol as a sclerosing agent following cyst aspiration. Vanishing of symptoms and decrease in size to 10% of the initial size were accepted as complete remission, decrease in size to 10–50% of the initial size was accepted as partial remission, and a return to the initial size of the cyst in a short time or decrease in size > 50% of the initial size was accepted as failure. The results of an average of 14 months’ follow-up are reported. Complete remission was seen in 18 (62%) patients, partial remission was seen in 5 (17.2%) patients, and failure was observed in 6 (20.68%) patients during an average of 14 months’ follow-up. Percutaneous sclerotherapy using polidocanol can be used safely and with low complication rates in the elderly population with comorbidities.

Comparison of single session alcohol injection effects on treatment of simple renal cysts

article: Comparison of single session alcohol injection effects on treatment of simple renal cysts - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 July-August;178(7-8):555-9 - Minerva Medica - Journals

Comparative study of percutaneous nephroscopy surgery and laparoscopic surgery for the treatment of simple renal cysts

Objective To compare the efficacy and safety of percutaneous nephroscopy surgery and laparoscopic surgery for the treatment of simple renal cysts. Methods Forty patients with simple renal cysts were retrospectively analyzed from April 2012 to December 2016. They were treated by laparoscopic renal cyst unroofing decompression (laparoscopic group, 20 cases) and percutaneous nephroscopy cyst unroofing decompression (percutaneous nephroscopy group, 20 cases). The mean operation time, operation bleeding, the rate of postoperative complications (infection, fever, urine leakage), hospitalization time after operation, and follow-up data after 6 months were compared between the two groups. Results All the 40 operations were successfully performed. The clinical cure rate of two groups was 100%, the mean operation time, the operation bleeding, postoperative complications and hospitalization time after operation between the two groups were not significant difference. The postoperative drainage of percutaneous nephroscopy group was more than that of laparoscopic group, the difference was statistically significant (P<0.001). During the follow-up of 6 months, no recurrence was found in the two groups, patient's satisfaction of percutaneous nephroscopy group was better than laparoscopic group, the difference was statistically significant (P<0.001). Conclusions Percutaneous nephroscopy and laparoscopic surgery are effective and security for the treatment of simple renal cyst. At present, percutaneous nephroscopy cyst unroofing decompression is an alternative method and is worth promoting with the increase of experience. Key words: Kidney Diseases; Cysts; Laparoscopy; Decompression, Surgical; Nephrostomy, Percutaneous

Abstract No. 704 Single-session 99.5% ethanol sclerotherapy for simple renal cysts: comparison of 40- and 120-minute retention techniques

To compare the results of 40- and 120-minute ethanol sclerotherapies which were performed in a single session for the management of simple renal cysts. We retrospectively reviewed 63 renal cysts in 62 patients treated by single-session percutaneous ethanol sclerotherapy. Thirty-two cysts in 31 patients underwent 40-minute sclerotherapy (group A) and 31 cysts in 31 patients underwent 120-minute retention technique (group B). Under ultrasonographic and fluoroscopic guidance, the cystic fluid was completely aspirated and 50% of the aspirated volume replaced with 99.5% ethanol (maximum, 100 mL). Follow-up of the patients were performed with ultrasonography or computed tomography (CT) at 3 months after sclerotherapy. Overall, technical success rates were 100% in both two groups. Eighteen patients (28.6%) were symptomatic (flank pain or discomfort). Indications of the other patients were large cyst (>5cm; 46%) and increment of the diameter on serial studies (25.4%). There was no significant difference between the two groups in terms of age (62.22 vs. 62.48 years), cyst diameter (8.43 vs. 8.14 cm), volume of aspirated fluid (230.06 vs. 250.16 mL), volume of injected ethanol (77.81 vs. 70.48 mL), and percentage of decrement of cyst diameter (58.6 vs. 53.67%) (P>0.05). After the treatment, flank pain or discomfort resolved in 17 (94.4%) of 18 symptomatic patients. One patient complained persistent flank pain, but no significant abnormality was detected on post-procedural CT images. There were no other complications after therapy in two groups. Single-session ethanol sclerotherapy with 40-minute retention technique is an effective and safe method for the treatment of simple renal cysts. It can reduce the procedural time and length of hospital stay, but there is no statistical difference in therapeutic efficacy between 40- and 120-minute therapies.

Comparison of different surgical in the treatment of simple renal cysts

Objective To explore and analyze the effect of different surgical in the treatment of simple renal cysts. Methods A total of 108 patients with simple renal cysts in our hospital from June 2014 to July 2016 were selected. All patients were randomly divided into experimental group and control group. In the experimental group, 50 patients were treated with percutaneous renal puncture and absolute alcohol (PAES), and 58 patients in the control group were treated with laparoscopic renal cyst. Postoperative recovery condition, operation effect and the cost of the patients were collected and compared with the statistical analysis. Results There was not statistically significant in age, gender, renal cyst, renal cyst type data between the two groups (P>0.05). The incidence of complications in the two groups was not significantly associated with the rate of surgical treatment and the choice of treatment, and the comparison was not statistically significant (P>0.05). Operation time, the cost of treatment, hospitalization time after surgery and the selected treatment had a certain correlation results, the difference was statistical significant (P<0.05). The postoperative follow-up of two patients for 12 months, the average amount of epispastic bursa fluid in the experimental group was (135±17.9) mL, 99% ethanol injection required average(34±6.4) mL.Extraction of cystic fluid colors of all pa-tients were light yellow or colorless, bacterial culture and cell examination showed no positive control. Postoperative data of follow-up were postoperative cyst without recurrence in 55 cases and relapsed operation in 3 cases. Conclusions For patients with renal cysts, PAES and laparoscopic renal cyst to the top of each have advantages and disadvantages, the specific implementation of the program should be based on the patient's own situation. PAES surgery has advantages of fewer complications, low expense, less pain, quick recovery. And laparoscopic renal cyst removal is applicable to other types of renal cyst patients, including huge renal cysts, multiple renal cysts or malignant patients can not be excluded. If the patient is poor or ineffective by PEAS or the implementation of percutaneous renal puncture is not easy, should be considered to go to the top of the laparoscopic renal cyst. Key words: Kidney Diseases; Cysts; Laparoscopes

A Rare Complication of the Treatment of Simple Renal Cysts: Nephrostomy Catheter Breakage after Alcohol Treatment and Laparoscopic Management

A Rare Complication of the Treatment of Simple Renal Cysts: Nephrostomy Catheter Breakage after Alcohol Treatment and Laparoscopic Management

Comparison of acetic acid and ethanol sclerotherapy for simple renal cysts: clinical experience with 86 patients.

Background To compare the efficacy and treatment session numbers of acetic acid to that of ethanol sclerotherapy for the treatment of simple renal cysts. Between February 2004 and June 2013, 86 patients with simple renal cysts underwent percutaneous aspiration and injection of 50 %-acetic-acid (42 cysts) and 95 %-ethanol (44 cysts). The patient demographics, volume reduction rate, number of treatment sessions, and complications were then analyzed.ResultsThe volume reduction rate was 94.1 ± 7.6 % in the 50 %-acetic acid group and 94.7 ± 11.7 % in the 95 %-ethanol group, and without a statistical difference. The rates of complete remission, partial remission, and no response were 57.1, 42.9 and 0 %, respectively, for the acetic acid group, and 70.5, 25.0, and 4.5 %, respectively, for the ethanol group. No statistical difference was observed between the two groups. Compared to the acetic acid group, the ethanol group had a higher number of treatment sessions, i.e. 1.10 ± 0.30 in the acetic acid group and 1.80 ± 0.79 in the ethanol group. Mild flank pain was a minor complication that occurred in both groups.ConclusionsAcetic acid seems to have equivalent sclerosing effects on simple renal cysts compared with those of ethanol despites of fewer treatment sessions.

A Meta analysis of retroperitoneal laparoscopy and open surgical treatment for renal cyst

Objective To evaluate the clinical efficacy and safety of retroperitoneal laparoscopy and open surgical treatment of simple renal cyst by Meta analysis. Methods Computer retrieval of MEDLINE, Cochrane Library, EMBASE, CNKI, Wanfang and VIP databases, according to the inclusion and exclusion criteria collected and screened out a randomized controlled studies on the treatment of simple renal cysts, published from January 1, 2000 to August 31, 2015. Two independent authors screened out randomized clinical trials (RCTs), extracted data, assessed quality of data, and then carried out Meta analysis by Revman 5.0 software with related data. Results Twenty one studies met the inclusion criteria with a total of 2 296 patients, including 1 162 patients of retroperitoneal laparoscopy and 1 134 cases of open operation group. Compared to the open operation group, retroperitoneal laparoscopy showed shorter operation time, less bleeding, shorter hospitalization time, and earlier postoperative drainage tube extraction time. No significant difference was found in the recurrence rate of the cyst for two groups. Conclusions The clinical efficacy, safety, and complication of retroperitoneal laparoscopy in the treatment of simple renal cyst is better than the open operation. Key words: Laparoscopy; Decompression, surgical; Kidney neoplasms/SU; Meta-analysis

Percutaneous Sclerotherapy with Aethoxysklerol in the Treatment of Simple Renal Cyst: A Five-Year Experience of a Single Institution

Percutaneous Sclerotherapy with Aethoxysklerol in the Treatment of Simple Renal Cyst: A Five-Year Experience of a Single Institution

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.

Comparison between the use of 99% ethanol and 3% polidocanol in percutaneous echoguided sclerotherapy treatment of simple renal cysts.

Aim:In this study, we compared and valued efficacy and safety of percutaneous echoguided sclerotherapy (PES) using 3% polidocanol with that using 99% ethanol in the treatment of patients with simple renal cysts.Materials and Methods:PES was performed for 65 simple renal cysts. Under ultrasonographic guidance the cyst was punctured using an 18 gauge needle. Sclerotherapy was performed with ethanol in 55% (36/65) of cases and with polidocanol in the remaining 45% (29/65). Patients were followed up with an ultrasound examination at 4 months, 8 months, and then at yearly intervals. A reduction of 50% or greater in cyst diameter was considered successful.Results:The median followup period for the ethanol and polidocanol groups was 24.6 and 22.8 months, respectively. The successful outcome ratio of the polidocanol group was significantly higher (90% vs. 61%, respectively) than the one of the ethanol group (P = 0.003). The partial regression of the ethanol and polidocanol groups were 6% versus 7%, respectively. The failure ratio of the polidocanol group was significantly lower (3% vs. 33%, respectively) than that of the ethanol group (P = 0.004). Neither infectious complications nor hyperthermia occurred in all treated cases. However, these methods are not completely free from symptoms. All these symptoms disappeared few hours after the procedure.Conclusions:Polidocanol is a safe and effective sclerosing agent for renal cysts, with superior clinical results than ethanol. Therefore, polidocanol can be an alternative to ethanol in sclerotherapy of renal cysts.

CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

ObjectiveThe aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts.Materials and MethodsSixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination.ResultsAfter the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group.ConclusionMonitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.