Treatment Of Symptomatic Renal Cysts Research Articles

Особенности хирургического лечения кист почек с учетом риска малигнизации

According to national and foreign publications, renal cyst is one of the most common urological diseases with a prevalence up to 20-50%.To determine the results of surgical treatment of patients with renal cysts, depending on the risk of malignancy.The analysis of 124 patients with symptomatic renal cysts who were treated in the Department of Urology of Regional Clinical Hospital was carried out. All patients underwent a comprehensive clinical and instrumental evaluation, including contrast-enhanced CT scan of the kidneys. To assess the risk of harboring malignant tumor, the classification of renal cysts of Bosniak (2019) was used.The average age of patients was 56.6+/-12 years. According to CT, Bosniak I, II, IIF and III cysts were diagnosed in 96 (77.4%), 11 (8.9%), 11 (8.9%) and 6 (4.8%) patients, respectively. The morphologic study revealed renal cell cancer in 8 patients (6.4%), four of whom had Bosniak III cysts and other four had Bosniak IIF cysts.The prediction of the harboring of malignancy is a fundamental criterion for selection of patients with renal cysts for surgical treatment.Surgical treatment of symptomatic renal cysts is a justified treatment method, and in patients with Bosniak class II or higher cysts, it is necessary to exclude the malignant lesion. Based on our data, category IIF and III cysts have a high risk of harboring malignant cells, which is 36.4% and 66.7%, respectively. In our opinion, laparoscopic partial nephrectomy is the most rational treatment method in these categories.

Laparoscopic transperitoneal renal cyst decortication

The aim of this study was to report our experience with the llaparoscopic transperitoneal treatment of simple renal cysts, to analyze the immediate and long-term clinical outcomes, and to evaluate the efficacy and safety of this miniinvasive surgical technique. Between 2009 and 2014 we diagnosed and treated a total of 48 patients with symptomatic simple renal cysts. The diagnosis was set up by ultrasound (US) and/or computed tomography (CT) examination. All cases were managed by transperitoneal laparoscopic cyst decortication. Demographic data, perioperative blood loss, duration of operative procedure, length of hospital stay and peri- and postoperative complications were analyzed. Follow-up included clinical examination and renal US, performed at 3-monthly intervals during the first year and yearly thereafter. Patient age ranged from 32 to 68 years (mean age 52.4 years). 27 (56.2%) of the patients were males and 21 (43.8%)--females. 42 (87.5%) of the cysts were peripheral, and 6 (12.5%)-peripelvic; 28 (58.3%) were localized to the left and 20 (41.7%)--to the right; and they ranged by size from 5 to 30 cm (mean 9.8 cm). 45 (93.8%) of the cysts were identified as category I, and only 3 (6.2%)--as category II, according to the Bosniak classification. None of the cases required conversion to open surgery. There were no peri- and postoperative complications. The average duration of the laparoscopic procedure was 55 min, and the average perioperative blood loss--50 mL. All patients had negative cytological and histological findings indicative for malignancy. The follow-up period ranged from 5 to 52ain months (average--25.4 months). In 47 cases (97.9%) exellent therapeutic results were reported: complete relief of clinical symptoms, fast recovery of physical activity and patient quality of life. There were three recurrences (6.2%) met in patients with multiple cysts, but only one of them required repeated surgery. Laparoscopic transperitoneal decortication is a miniinvasive, highly effective and safe method of treatment of symptomatic renal cysts. The immediate relief of clinical symptoms, the short period of reconvalescence, the excellent quality of life after surgery, and the low relapse rate confidently define it as the surgical method of choice.

Laparoendoscopic Single-Site Surgery for Symptomatic Renal Cyst Decortication Using a Homemade Glove Port Device: Initial Experience

Objectives: Laparoendoscopic single-site surgery (LESS) has recently gained popularity in urology. There are few large series reports on LESS for symptomatic renal cysts. We evaluated the clinical utility and safety of LESS in 62 symptomatic renal cyst decortication patients by using a homemade glove port device. Materials and Methods: We reviewed our series of 62 LESS for symptomatic renal cyst (20 Bosniak type I and 42 Bosniak type II) decortication performed from November 2009 to December 2010. A homemade glove port device was placed through an umbilical incision. The perioperative clinical parameters were reviewed retrospectively. Results: Of 62 cases that underwent LESS for renal cyst ablation successfully, there were no major perioperative complications, but 2 minor complications (transient fever and mild ileus) were found. The mean operative time was 61.4 ± 27.4 min and the mean estimated blood loss was 20.1 ± 11.3 ml. The mean pre- and postoperative pain scores were 6.94 ± 1.1 (range 5–10) and 1.3 ± 1.2 (0–5), respectively (p = 0.000). Conclusions: Our results suggest that LESS is a safe and feasible alternative to conventional laparoscopic surgery for the treatment of symptomatic renal cysts.

Place de la ponction-sclérothérapie à la polyvidone-iodine dans le traitement des kystes rénaux simples symptomatiques

To assess prospectively the results of percutaneous sclerotherapy with povidone-iodine of symptomatic renal cysts in adults. Fifty two patients were included in this study from august 2004 to november 2006. The operative indication was: pain (41 cases), urinary tract compression (8 cases), and very large cyst (3 cases). The preoperative assessment (site and dimensions of the cyst) always included ultrasonography. CT scan, for morphological assessment, was performed in 39 cases. The mean age of patients was 63 years (47-75 years). The mean diameter was 76 mm. The cysts were punctured in all the cases directly under local anaesthesia and guided by sonography. The procedure was very well tolerated in every case, with external drainage for 72 hours. Clinical regression was complete in 48 cases (92%), with total ultrasonographic disappearing of the cysts in 31 cases (60%) with a mean follow-up of 14 months (3-29 months). Percutaneous sclerotherapy with povidone-iodine is a safe, effective and reproducible treatment of symptomatic renal cysts in adults.

Tratamiento laparoscópico de quistes renales simples sintomáticos

Simple renal cysts (SRC) are usually asymptomatic and do not require any kind of treatment. Laparoscopy is a reasonable minimally invasive surgical option for symptomatic cysts. Herein, we present the results of the laparoscopic technique for the treatment of symptomatic renal cysts performed in our institution. Between November 1992 and May 2006, 41 patients with symptomatic renal cysts were laparoscopically treated. The surgical techniques employed were transperitoneal and retroperitoneal. Demographic and surgical data was prospectively collected and analysis retrospectively performed. 41 patients were treated for symptomatic renal cysts in a fourteen year period. 23 (56%) women and 18 (44%) men, with a median age of 54 years. (Range 27-74 years.). All patients in the series were symptomatic. Pain was the most frequent symptom. Median cyst size was 10 cm. (range 5-16 cm.). Transperitoneal approach was performed in 24 patients (58%) and retroperitoneal in 17(42%). No differences were verified between these approaches. 16 lesions were located at the left renal unit, 24 in the right renal unit (54%) and one case presented bilateral lesions (3%). Median operative time was 52 min. (range 20-150 min.), median hospital stay was 42 hours (range 12-96 h.). 39 cysts (95.2%) were classified as Bosniak's type I lesions, 2 lesions (4.8%) were type II based on Bosniak's description. Final pathology confirmed every lesion as a simple renal cyst. There was only one relapse in the series. The latter was treated percutaneously. Laparoscopy is a feasible, safe and advantageous surgical therapeutic option for symptomatic renal cysts.

Povidone–Iodine Sclerotherapy Is Ineffective in the Treatment of Symptomatic Renal Cysts

To evaluate the efficacy of povidone-iodine sclerotherapy after percutaneous drainage of simple renal cysts in the treatment of symptomatic patients. Sixteen patients with symptomatic renal cysts were treated by percutaneous drainage and injection of povidone-iodine solution. The cysts were drained by a nephrostomy tube catheter, and povidone- iodine injections were repeated every 24 hours for 3 days. All patients were followed up by ultrasound examination during a period ranging from 1 to 4 years (mean 1.8 years). Thirteen patients experienced recurrence of cysts, while complete resolution was observed in only three patients. Of the cysts that recurred, only partial resolution in cyst diameter was observed (from 3-10.5 cm to 2.4-8.6 cm). During the follow-up period, 12 of the 16 patients (75%) continued to have pain that necessitated additional treatments. Povidone-iodine sclerotherapy is followed by a high rate of recurrence and is therefore not indicated for the treatment of symptomatic simple renal cysts.

Treatment of Simple Renal Cysts with Single-Session Percutaneous Ethanol Sclerotherapy without Drainage of the Sclerosing Agent

To evaluate percutaneous single-session sclerotherapy with ethanol without drainage of the sclerosing agent in symptomatic simple renal cysts that require treatment. A prospective series of 30 consecutive patients with symptomatic simple renal cysts with volume of 280.3 +/- 365.23 mL (range 28-1700 mL) estimated by ultrasonography were treated between July 1999 and July 2003. The cysts were punctured with an 18-gauge, 20-cm needle under ultrasound guidance and local anesthesia. A volume of ethanol equivalent to one third of the aspirated volume, up to a maximum of 100 mL, was injected into the cyst and left there. The patients were reassessed at 1, 3, and 6 months. The procedure was technically feasible in all patients. The aspirated volume was 259.8 +/- 265.2 mL (range 30-1900 mL). After 1, 3, and 6 months, the average volume was 52.7 +/- 71.4 mL, 22.7 +/- 43.2 mL, and 11.6 +/- 30.7 mL, respectively. After this period, 28 patients (93%) were asymptomatic, showing total remission of the cyst (17 cases) or at least a 90% decrease (10 cases) or a 50% decrease (1 case) in the initial volume. One patient (3%) had a 50% reduction of the cyst and persistent symptoms, and one patient (3%) had persisting symptoms despite the total remission of the cyst. Single-session percutaneous sclerotherapy with ethanol is a good option for the treatment of symptomatic renal cysts, as it is highly effective and offers the benefits of a less-invasive procedure.

Renal Cysts: Can Percutaneous Ethanol Injections Be Considered an Alternative to Surgery?

Aim: To evaluate the efficacy of a new sclerotization technique with pure ethanol in the treatment of symptomatic renal cysts. Patients and Methods: Fourteen patients having renal cysts with a meant diameter of 10 (range 5–15) cm were treated. Our technique includes: ultrasound-guided percutaneous puncture with an 18-gauge needle, positioning of a 5-Fr catheter, complete cyst fluid aspiration, injection of pure alcohol equal to 15% of the initial cyst volume, and alcohol aspiration after 90 min. The procedure was repeated eight times within 5 days. The patients were followed up by ultrasound and/or CT scan for 1 year. Results: All patients became symptom free. Follow-up showed a progressive reduction of the cyst diameter in all cases. Three cysts only (in 2 patients; cyst diameter <2 cm) persisted after 12 months. No significant complications were observed. Conclusions: In our experience, injections of pure ethanol in renal cysts, repeated after some days, were effective in eliminating recurrences and related symptoms. The procedure was not associated with significant complications. Our findings suggest that it be considered the first-choice procedure in the treatment of renal cysts, due to the good results and the low cost of ethanol.

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).

Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts.

To assess the effectiveness and long-term results of two repeated ethanol injections in the treatment of symptomatic renal cysts. Sixty-eight patients 47 to 75 years old with 77 large (6.3-14.8 cm; mean 8.62 cm) symptomatic cysts were included in this study. Of the 68 patients, in 4 cases there were renal cysts associated with renal calculi. An 8FR Pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of cystic fluid. Two repeated ethanol 95% injections were performed every 24 hours. Patients were followed-up by ultrasonography for a period of 12-48 months (mean 30). In two patients the cyst puncture was not feasible because of poor visualization of puncture site while in one patient there was communication of cystic cavity with the pelvocaliceal system. In these patients surgical resection of cysts was performed. Complete and partial regression rates were 57/68 (83.82%) and 8/68 (11.76%) respectively. In four patients with renal stones and renal cysts, extracorporeal shock wave lithotripsy (ESWL) was successfully executed I month after sclerotherapy. Our results suggest that percutaneous aspiration followed by two repeated ethanol injections is highly effective on reducing recurrence of simple renal cysts.