Korean J Urol.  2011 Oct;52(10):693-697. 10.4111/kju.2011.52.10.693.

Percutaneous Decortication of Cystic Renal Disease

• Hamedanchi S
• Tehranchi

• KMID: 2061432
• DOI: http://doi.org/10.4111/kju.2011.52.10.693

Abstract

PURPOSE
To assess the efficacy of percutaneous unroofing in the treatment of simple renal cysts instead of laparoscopic decortication and open surgeries.
MATERIALS AND METHODS
From November 2009 to October 2010 at our department, 11 patients with 12 simple cyst units were managed by percutaneous unroofing. All cysts were evaluated with ultrasonography and abdominal computed tomography. If there were no contraindications, cyst wall resection was performed. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterized. The drain was left in place for 2 days.
RESULTS
At the 5-month follow-up, patients were asked about their symptoms and ultrasonography was performed. From 12 cyst units, 8 were completely resolved, 3 were reduced to less than 50%, and 1 was persistent to near its original size. Success was defined as a more than 50% reduction in cyst volume.
CONCLUSIONS
Simple renal cysts can be safely managed by percutaneous unroofing with a success rate of more than 90%. This technique can offer several advantages over open surgery, such as decreased length of hospital stay, improved convalescence, and reduced risk of complications. Percutaneous resection also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy.

Keyword

Cysts; Cystic renal disease; Endoscopy; Kidney diseases; Management

MeSH Terms

Convalescence
Endoscopy
Follow-Up Studies
Humans
Hypogonadism
Kidney Diseases
Kidney Diseases, Cystic
Laparoscopy
Length of Stay
Mitochondrial Diseases
Ophthalmoplegia
Surgical Instruments
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  FIG. 1 Right renal simple cyst.

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  FIG. 2 Percutaneous resection of a renal cyst using a resectoscope.

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  FIG. 3 Cauterising the parenchymal portion of the cyst.

Reference

1. Laucks SP Jr, McLachlan MS. Aging and simple cysts of the kidney. Br J Radiol. 1981; 54:12–14. PMID: 7448493.

2. McAninch JW. Tanagho EA, Mcaninch JW, editors. Disorders of the Kidneys. Smiths general urology. 2008. 17th ed. New York: Mc Graw Hill;p. 510–511.

3. Amar AD, Das S. Surgical management of benign renal cysts causing obstruction of renal pelvis. Urology. 1984; 24:429–433. PMID: 6495450.

4. Bosniak MA. The current radiological approach to renal cysts. Radiology. 1986; 158:1–10. PMID: 3510019.

5. Kretschmer HL. Solitary cyst of the kidney. JAMA. 1930; 95:179–182.

6. Holmberg G, Hietala SO. Treatment of simple renal cysts by percutaneous puncture and instillation of bismuth-phosphate. Scand J Urol Nephrol. 1989; 23:207–212. PMID: 2799295.

7. Ohta S, Fujishiro Y, Fuse H. Polidocanol sclerotherapy for simple renal cysts. Urol Int. 1997; 58:145–147. PMID: 9188134.

8. Phelan M, Zajko A, Hrebinko RL. Preliminary results of percutaneous treatment of renal cysts with povidone-iodine sclerosis. Urology. 1999; 53:816–817. PMID: 10197864.

9. Su Li-Ming. Gill IS, editor. laparoscopic renal cyst ablation. Textbook of laparoscopic urology. 2006. 1st ed. New York: Informa Healthcare;p. 259.

10. Hulbert JC, Shepard TG, Evans RM. Laparoscopic surgery for renal cystic disease. J Urol. 1992; 147:882.

11. Rubenstein SC, Hulbert JC, Pharand D, Schuessler WW, Vancaillie TG, Kavoussi LR. Laparoscopic ablation of symptomatic renal cysts. J Urol. 1993; 150:1103–1106. PMID: 8371363.

12. Roberts WW, Bluebond-Langner R, Boyle KE, Jarrett TW, Kavoussi LR. Laparoscopic ablation of symptomatic parenchymal and peripelvic renal cysts. Urology. 2001; 58:165–169. PMID: 11489690.

13. Kropp KA, Grayhack JT, Wendel RM, Dahl DS. Morbidity and mortality of renal exploration for cyst. Surg Gynecol Obstet. 1967; 125:803–806. PMID: 6041724.

14. Gelet A, Sanseverino R, Martin X, Levegue JM, Dubernard JM. Percutaneous treatment of benign renal cysts. Eur Urol. 1990; 18:248–252. PMID: 2289516.

15. Plas EG, Hübner WA. Percutaneous resection of renal cysts: a long-term followup. J Urol. 1993; 149:703–705. PMID: 8455226.