Percutaneous injection sclerotherapy with minocycline hydrochloride for simple renal cysts

Percutaneous injection of minocycline in postoperative sialocele following condylar fracture

Sialocele is a common complication of parotid tumour surgery. Aspiration and pressure dressing are the most common conservative treatments for sialoceles. However, they occasionally exhibit a refractory nature. In this case report, a minocycline injection was administered for refractory sialocele following a condylar fracture treated using the retromandibular anterior transparotid approach. Aspiration of the sialocele and the same amount of minocycline injection using three-way stopcocks were performed four weeks after surgery. After the injection, the buccal swelling completely disappeared without complications, including facial palsy. Percutaneous injection of minocycline might be the first choice for postoperative refractory sialocele following condylar fracture.

Symptomatic Liver Cyst Successfully Treated with Transgastric Drainage and Sclerotherapy Using Minocycline Hydrochloride

A liver cyst is hepatic fluid-filled cavities often detected in clinical surveillances such as a health examination. Although the liver cyst is usually asymptomatic and observed without any therapeutic intervention, it can be symptomatic and needs treatment due to its enlargement, hemorrhage, and infection. A 74-year-old woman presented with upper abdominal pain and a huge liver cyst in the left lobe. Several examinations including image findings revealed that the symptom could be derived from the liver cyst. Although there is no definite guideline of treatment for symptomatic liver cysts, percutaneous ultrasound-guided drainage with sclerotherapy or surgery is often selected. Because of anatomical accessibility to the liver cyst and the patient's wish, we performed endoscopic transgastric drainage with insertion of both an internal stent and an external nasocystic tube. Sclerotherapy with minocycline hydrochloride was performed through the nasocystic tube, and the liver cyst shrunk completely without any complications. This is the first reported method of administering minocycline hydrochloride through a nasocystic tube, which can be a therapeutic option for patients with symptomatic liver cysts.

Isolated renal hydatid cyst

INTRODUCTION AND IMPORTANCE

Hydatid disease, is a parasitic disease caused by the larval stage of the cestode Echinococcus granulosus. The Liver and lungs are the commonly affected organs but rarely kidney can be affected. Patient with primary renal hydatid may present with nonspecific symptoms or may be diagnosed incidentally. Imaging and serology are useful for diagnosis. The best therapy is surgery.

CASE PRESENTATION

This case is reported to discuss a 35-year-old female presented with complaints of left side flank pain and swelling. The abdominal US and CECT show renal cyst, which was nonspecific. She underwent an open surgical exploration and cystectomy plus partial pericystectomy done. Post-operative serology test show Echinococcus IgG positive. Postoperatively, the patient had an uneventful recovery and discharged with Albendazole therapy for 8 weeks.

CLINICAL DISCUSSION

Renal hydatid cyst is rare, accounting for less than 2 to 3 % of all hydatid disease. Renal hydatid cysts can remain asymptomatic for many years and then can be discovered incidentally. The diagnosis and staging of renal hydatid cysts rely heavily on imaging and serology. Hydatid disease is primarily treated surgically.

CONCLUSION

A high index of suspicion should be maintained, especially in endemic areas, to ensure timely and accurate diagnosis of renal hydatid cyst. Surgical excision remains the treatment of choice, with appropriate preoperative and postoperative anthelminthic therapy. Long-term follow-up is crucial to monitor for recurrence and associated complications.

Simple drainage versus drainage with minocycline infusion for symptomatic hepatic cysts

Percutaneous treatment of symptomatic hepatic cysts includes simple drainage and drainage with sclerosing agents. We compared the efficacy of simple drainage with that of drainage with minocycline infusion for treating symptomatic hepatic cysts. We retrospectively evaluated 11 patients who underwent percutaneous drainage of symptomatic hepatic cysts. In seven cases, minocycline infusion was added at the discretion of the clinician. Cyst volume was evaluated before drainage, immediately after drainage, and after long-term follow-up. Cyst volume was calculated before treatment by multiplying the orthogonal diameters using the ellipsoid formula. Relapse was defined as the regrowth of the cyst with symptoms. Cyst volume immediately after drainage and after long-term follow-up was significantly less than that before treatment for the drainage with minocycline infusion group (p<0.05) but not for the simple drainage group. The relapse rates were 25% (1/4) for the simple drainage group and 0% for the drainage with minocycline infusion group. Drainage with minocycline infusion could be a promising option for treating symptomatic hepatic cysts, although simple drainage was not reliable.

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.

Infected hepatic cyst following pancreatoduodenectomy treated with transhepatic drainage and minocycline hydrochloride injection: A case report

INTRODUCTION

Asymptomatic hepatic cysts, often observed on computed tomography, have never been reported as a risk factor for infection following pancreatoduodenectomy. Symptomatic liver cysts are treated surgically or non-surgically. We encountered a case of infected hepatic cyst following pancreatoduodenectomy.

PRESENTATION OF CASE

An 88-year-old woman underwent pancreatoduodenectomy for adenocarcinoma in the duodenum papilla of Vater. She was discharged (postoperative day 23), following an uneventful course. However, 7 days later, she was re-admitted because of a high fever; postoperative cholangitis was suspected. A peripheral-venous blood bacterial culture was negative. Her C-reactive protein level and white blood cell count were 0.57 mg/dl and 5290/μl, respectively. Antibiotics were administered, but her high fever only temporarily decreased. Contrast-enhanced computed tomography showed ring enhancement surrounding the largest of several hepatic cysts. Percutaneous transhepatic drainage was performed; thereafter, minocycline hydrochloride was repeatedly injected into the infected cyst through the drain to prevent infection recurrence. The drain was removed 49 days after drainage. On contrast-enhanced computed tomography at 6 months postoperatively, the infected hepatic cyst had reduced in size from 6.0 to 1.7 cm and no findings of bile duct stenosis were observed. No further infectious events have been observed.

DISCUSSION

Relatively large hepatic cysts may be at risk of infection following pancreatoduodenectomy and, in particular, biliary reconstruction.

CONCLUSION

Transhepatic drainage, rather than antibiotic administration, is essential, and minocycline hydrochloride injection into infected cyst that have no evidence of communication with the biliary tree is effective in preventing infection recurrence, without the complication of bile duct stenosis.

Hyperuricemia and overexcretion of uric acid increase the risk of simple renal cysts in type 2 diabetes

Previous studies have discussed the relationship between simple renal cysts (SRC) and serum uric acid level in healthy individuals. We performed a cross-sectional study to evaluate the association between serum uric acid level and fractional excretion of uric acid (FEUA) and simple renal cysts in males and postmenopausal females with type 2 diabetes. The overall prevalence of SRC was 18.1% in our population. SRC prevalence was significantly higher in hyperuricemic than normouricemic subjects (27.3% vs. 16.8%, P < 0.001). Subjects who overexcreted uric acid had a higher prevalence of SRC than underexcretors (total population: 21.6% vs. 16.3%; normouricemic subjects: 19.8% vs. 13.7%; hyperuricemic subjects: 50.0% vs. 22.7%, all P-values < 0.05). Hyperuricemia (odds ratio [OR] 1.824, 95% confidence interval [CI] 1.332-2.498, P < 0.001); FEUA (OR 1.046, 95% CI 1.002-1.091, P < 0.05); male gender (OR 1.922, 95% CI 1.489-2.480, P < 0.001); age (OR 1.049, 95% CI 1.035-1.064, P < 0.001); and albuminuria (OR 1.492, 95% CI 1.176-1.892, P < 0.01) were independent risk factors for SRC development. These findings suggested that hyperuricemia and high level of FEUA were both independent risk factors for SRC development in males and postmenopausal females with type 2 diabetes. Half of overproduction hyperuricemic patients had SRC.

Primary Renal Echinococcosis

Echinococcosis is a parasitic infection caused by the larval stage of a cestode Echinococcus granulosus and is endemic in sheep farming regions of developing countries. It manifests as hydatid cyst and most commonly is found in liver followed by lungs. Renal hydatid cyst is rare and amounts for 2% of all cases. There are no specific clinical manifestations, and hence diagnosis of renal hydatid disease is missed out easily without imaging. We report a case of 50-year-old female who had 6 months history of lower abdominal pain with hematuria, found to have right renal hydatid cyst on imaging which was treated with right nephrectomy with pre- and post-operative albendazole treatment.

Sclerotic Effect of Oxytetracycline on the Submandibular Gland: An Experimental Model

Oxytetracycline has been suggested as an alternate therapy for chronic recurrent sialadenitis and sialorrhea. We conducted an experimental study to investigate the sclerotic effect of this drug on the submandibular gland by histopathologic methods. Our subjects were 20 New Zealand white rabbits, which were divided into two groups of 10. The right submandibular gland of the rabbits in the active-treatment group was injected with 0.3 ml of oxytetracycline (100 mg/ml), and that of the controls was injected with saline. Four weeks after the injections, all the glands were removed. Histopathologic studies, including hematoxylin and eosin and Masson trichrome staining, were carried out. The glands were evaluated for tissue inflammation, congestion, fibrosis, edema, lipomatosis, and atrophy. To investigate apoptosis, terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) immunohistochemical staining was used. In the study group, inflammation (n = 9), congestion (n = 9), fibrosis (n = 6), edema (n = 6), and lipomatosis (n = 4) were observed; in the sham group, only lipomatosis was seen (n = 5). The TUNEL assay results for acinar cells were 4.51 ± 1.41% in the oxytetracycline group and 2.08 ± 1.76% in the control group (p = 0.006); the corresponding figures for the duct cells were 7.05 ± 0.87% and 3.10 ± 2.26% (p = 0.001). Based on our findings, we conclude that oxytetracycline might be a viable alternative for the treatment of chronic recurrent sialadenitis and sialorrhea. However, more research in this area is needed.

The ole of Choice-Lck Catheter and Trocar Technique in Percutaneous Ablation of Symptomatic Renal Cysts

Background:

The most common benign lesions of the kidney are simple cysts. They are acquired lesions and mostly affect the elderly population.

Objectives:

To describe the usage of choice-lock catheter and trocar technique in percutaneous renal cyst treatment and determining long-term outcomes.

Patients and Methods:

This retrospective study was carried out between February 2000 and July 2011. Eighty-eight cysts all of which were Bosniak type-1 cysts were selected in 75 patients. The treatment indications were flank pain, hydronephrosis and hypertension. The choice-lock catheter was used for 84 cysts with the trocar technique. Ninety-five percent ethanol was used as the sclerosing agent. Maximum volume of the injected ethanol was 175 ml. The mean follow-up time after the treatment procedure was 23 months. Sixty-four cysts were located in the cortical and 24 cysts were located at the parapelvic region.

Results:

Fifty-seven cysts had complete regression, while 31 cysts regressed partially. After the procedure, pain was relieved in 44 (82%) patients and the pain alleviated in four (8%). Normotension was obtained in five (62.5%) of the eight hypertensive patients and no hydronephrosis was detected in nine patients. There were no relationship between the localization and the regression rate. No major complications occurred.

Conclusions:

Percutaneous ethanol sclerotheraphy in simple cysts is a safe, cost-effective and minimally invasive method. We consider that this technique may be an alternative solution in the percutaneous cyst treatment.

Diagnosis and surgical treatment of renal hydatid disease: a retrospective analysis of 30 cases

Echinococcosis (CE) is an infection which is caused by the larval stage of a tapeworm and is endemic in stockbreeding regions of developing countries. The kidney is the most commonly affected organ in the urinary tract. However, reports on renal hydatid disease are limited in the literature, and usually there are no specific clinical characteristics and promising operative methods. The purpose of this study is to assess the most appropriate surgical technique for the patient with urinary tract CE. We retrospectively analyzed thirty patients with renal hydatid cysts who received different surgical treatments in the urology department of the First Affiliated Hospital of Xinjiang Medical University from February 1985 to April 2010. Twenty patients were males and ten were females. The diagnostic accuracy was 74%, 87.5%, and 66.6% respectively by using of ultrasound, CT, and laboratory tests. Thirty patients were followed up for 1–15 years after surgery. One patient experienced a recurrence of renal CE. The ultrasound, CT, and immunological tests are an important means of diagnosis. The surgical treatment principle of renal hydatid should be based on residual renal function, hydatid cyst size, number, location, and surgical techniques to determine the surgical plan to retain the renal function.

Ten-year treatment outcomes including blood cell count disturbances in patients with simple renal cysts

BACKGROUND

The simple renal cyst is the most common benign kidney disease. It may cause pain and hypertension, especially if significantly enlarged. As in polycystic kidney disease, blood cell count disturbances are frequently observed in simple renal cysts. The aim of our study was to assess such disturbances, changes in blood pressure, and complication rate in our patients undergoing surgery due to simple renal cyst in the last 10 years.

MATERIAL AND METHODS

210 patients with simple renal cysts were underwent surgery between 2002 and 2012. Two different kinds of operation were conducted: aspiration of cyst fluid with injection of sclerosing agent, and laparoscopic/retroperitoneoscopic decortications of the cyst wall. A control group comprised 134 patients with benign prostate hyperplasia. The following data were obtained: cyst burden, hematocrit, hemoglobin, red blood cells, thrombocytes, occurrence of pain, and blood pressure before and after the operation. Complications were collected and presented in Clavien score.

RESULTS

Hematocrit, hemoglobin, and red blood cells were significantly increased in the experimental group. A positive correlation was observed between cyst burden and the parameters mentioned above. Of 91 patients with hypertension, 56 (61.7%) had blood pressure reduction after the operation. Treatment relieved the loin pain in 132 (88%) patients. Complications occurred in 15 (7.4%) patients.

CONCLUSIONS

Patients with simple renal cysts have high values of red blood cells, hematocrit, and hemoglobin. Treatment decreases blood pressure in patients with hypertension. Complications after treatment are rare and mild.

Unexpected outcome after sclerotherapy of simple renal cyst

Background

Simple renal cysts usually have benign clinical features. We report a rare case of papillary renal cell carcinoma (RCC) associated with a large recurrent simple cyst following sclerotherapy.

Case Presentation

A 47-year-old Japanese woman received minocycline sclerotherapy for a large (9 cm in diameter) simple left renal cyst in May 2005. The cyst regrew, and second-line sclerotherapy with ethanol was performed in November 2005. Three years later, she developed papillary RCC on the wall of the recurrent renal cyst. Radical nephrectomy was performed, but the patient died of metastatic disease 15 months after surgery.

Conclusion

Malignant transformation from recurrent simple renal cyst to RCC may occur in the years following sclerotherapy, underscoring the need for long-term follow-up.

Surgical management of renal cystic disease

The kidney is one of the most common sites for cyst in the body (prevalence about 5%). Symptomatic or incidental cyst needs to be characterized further based on Bosniak classification as simple (Bosniak type I & II) or complex (Bosniak type III & IV) cysts with respect to risk of malignancy or other effects on the kidney. The management of simple cysts is entirely for its symptoms or complications (eg, hemorrhage, infection, hydronephrosis, and hypertension). Percutaneous aspiration alone or with sclerotherapy often is the first-line treatment. Surgical decortication generally is reserved for recurrent or very large symptomatic cysts. Laparoscopic surgery is highly efficacious and is associated with high satisfaction rates with minimal morbidity. Retroperitoneal approach is generally preferred, especially in infected or hydatid renal cyst to avoid spillage or contamination of virgin peritoneal cavity. Cyst decortication seems to be an appropriate indication for newer-emerging single-port laparoscopic approaches such as natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, or laparoendoscopic single-site surgery. Where available, robot-assisted surgical management can supplant pure laparoscopic management for complex cysts, hydatid cyst, peripelvic cyst, and autosomal dominant polycystic kidney disease without any outstanding benefits, but with added cost, when robot is used.

Clinical experience of single-session percutaneous aspiration and OK-432 sclerotherapy for treatment of simple renal cysts: 1-year follow-up

PURPOSE

To evaluate the efficacy and safety of single-session OK-432 sclerotherapy for the treatment of renal cysts.

MATERIALS AND METHODS

From October 2005 to November 2006, 48 patients (61 simple renal cysts) were included in the study. Indications were determined as flank discomfort (n = 37) or patient reassurance due to increasing size (n = 11). The simple renal cysts were aspirated under ultrasonography (US), at which point OK-432 was injected into the cyst. Follow-up was performed with US or computed tomography scan every 3 months until 1 year. Complete regression of the renal cyst or more than 70% reduction in size with no symptoms indicated a successful treatment.

RESULTS

Among 61 renal cysts of 48 patients, the overall success rate was 98.4%. Complete regression occurred in 46 cysts (75.4%), and more than 90% reduction in size occurred in 6 cysts (9.8%). A size reduction of 80% to 90% and 70% to 80% occurred in five (8.2%) and three cysts (4.9%), respectively. A size reduction less than 70% occurred in only one cyst (1.6%). The success of cyst regression was correlated with cyst volume. Clinical symptoms resolved in 100% of patients with symptomatic cysts, and there was no enlargement of the aspirated cysts at the 1-year follow-up. After the procedure, there were only some minor complications, such as mild fever, flank pain, and leukocytosis, which subsided with the conservative treatment.

CONCLUSIONS

Percutaneous OK-432 sclerotherapy is simple, safe, and effective, and it can be an alternative first-line therapy for simple renal cysts.

Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts

OBJECTIVES

Symptomatic simple renal cysts can be treated by combination of percutaneous aspiration and sclerotherapy. A number of sclerosing agents including glucose, phenol, iophendylate, polidocanol, minocycline and pantopaque have been used in the past to prevent reformation of cyst. In this study, tetracycline HCL solution is evaluated as a sclerosant for treatment of simple renal cysts.

METHODS

Our study treated 76 cysts in 70 patients with symptomatic renal cysts. Aspiration and sclerotherapy was performed on 56 cysts, and 20 cysts aspirated without sclerotherapy as a control group. Treatment was performed under local anesthesia and punctured under ultrasound guidances with an 18-gauge needle. Tetracycline HCL (20%) was injected into the cystic cavity according to cyst diameter. All patients were followed up with an ultrasound examination at 3 months, 6 months, and then at yearly intervals. The reduction rate was estimated by a comparison of the volume of the cyst before and after treatment. A cyst reduction of 50% or greater in diamater was considered as a successful treatment.

RESULTS

The average follow-up period was 9.8 months in the sclerotherapy group and 9.9 months in the control group. The success rate was 85.7% in the sclerotherapy group. There was a significant difference in the reduction rate of tetracycline HCL sclerotherapy group and control group. No major complications were encountered.

Percutaneous treatment of renal cysts with OK-432 sclerosis

PURPOSE

The aim of this study was to demonstrate OK- 432 sclerotherapy efficacy for treatment of simple renal cysts.

MATERIALS AND METHODS

Twenty patients with 25 symptomatic or large simple cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of OK-432 (8 men and 12 women, mean age 63.6 years, SD 9.5). Six patients presented with flank pain, 14 presented with renal mass; renal cyst location was right, left, or bilateral sided in 9, 8, and 8 kidneys, respectively. Patients were evaluated by clinical assessment, US, or CT scan 3 months following the procedure. Complete and partial success was defined as symptom resolution with either total cyst ablation or greater than 70% reduction, respectively. Failure was defined as 30% of cyst size recurrence and/or persistent symptoms.

RESULTS

Average reduction was 93.0%. Complete and partial resolution occurred in 11 (44.0%) and 13 (52.0%) cysts, respectively. One case was defined as failure, with a 64.2% size reduction from 10.9cm to 3.9cm (volume reduction rate 95.4%). Renal pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 3 patients, 2 developed leukocytosis and 1 had mild fever (< 38.5 degrees C) following aspiration and sclerotherapy. Successful treatment was achieved with conservative measures and NSAID therapy.

CONCLUSION

Percutaneous treatment of simple renal cysts with OK-432 sclerotherapy was found to be a safe, effective and minimally invasive procedure.

Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors

OBJECTIVES

To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors.

METHODS

Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed.

RESULTS

One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 +/- 16.7 min (range, 50-135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 +/- 0.9 days (range, 1-4). After a mean follow up of 14.3 +/- 5.9 months (range, 3-24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney.

CONCLUSIONS

Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved.

Long-term results of single-session percutaneous drainage and ethanol sclerotherapy in simple renal cysts

PURPOSE

To demonstrate the efficacy and long-term results of the single-session ethanol sclerotherapy in simple renal cysts.

MATERIALS AND METHODS

Ninety-eight cysts in 97 patients (range: 18-76 years; mean age, 54 years) were included in the study. Indications were determined as flank pain in 74, hydronephrosis in 12, hypertension in 8, patient reassurance due to increasing cyst size in three patients. Mean follow-up period was 24.4 months. Procedures were performed with the guidance of fluoroscopy and ultrasonography at all times using 5-7 Fr pigtail catheters. After the cystogram that was obtained in all cases, 95% ethanol with a volume of 30-40% of the cyst volume was used as a sclerosing agent on an outpatient basis. Maximum volume of the injected ethanol was 200 ml. Follow-up examinations were performed 1, 3, 6 and 12 months after the procedure and once every year thereafter.

RESULTS

Average cyst volume reduction was 93% at the end of the first year. The cysts disappeared completely in 17 (17.5%) patients. After the procedure, in 67 (90%) patients improvement in flank pain was noted. Sixty-one (82%) patients were free of pain and in 6 (8%) of them the pain decreased. Normotension was obtained in 7 (87.5%) of the 8 hypertensive patients and no hydronephrosis was detected in 10 (83.3%) of the 12 patients after the procedure. Second intervention was required in 2 (2%) patients due to recurrence of cysts and related symptoms. One (1%) patient had small retroperitoneal hematoma that resolved spontaneously and in another (1%) patient spontaneous hemorrhage was detected into the cyst 1 year after the procedure. No other complication was detected during the procedure and follow-up.

CONCLUSION

Percutaneous treatment of simple renal cysts with single-session sclerotherapy is a safe, effective and minimally invasive procedure and can be used as an alternative to multiple-session sclerotherapy with comparable results. High volume, up to 200 ml ethanol can be used without adverse effects for large renal cysts.

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

PURPOSE

To evaluate percutaneous single-session sclerotherapy with ethanol without drainage of the sclerosing agent in symptomatic simple renal cysts that require treatment.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

Percutaneous sclerotherapy of renal cysts with a beta-emitting radionuclide, holmium-166-chitosan complex

OBJECTIVE

To evaluate the usefulness of a beta-emitting radionuclide (holmium-166-chitosan complex) as a sclerosing agent for the treatment of renal cysts.

MATERIALS AND METHODS

Using 10-30 mCi of holmium-166-chitosan complex, 20 renal cysts in 17 patients (14 male and 3 female patients, ranging in age from 47 to 82 years) were treated by percutaneous sclerotherapy under ultrasonographic guidance. The volume of the cysts before and after the sclerotherapy and the percentage change in volume were calculated in order to evaluate the response to therapy, which was classified as either complete regression (invisible), nearly complete regression (< 15 volume% of initial volume), partial regression (15-50 volume%) or no regression (> 50 volume%).

RESULTS

The follow-up period ranged from 6 to 36 months (mean 28 months). Eighteen cysts (90%) regressed completely (n=11, 55%) or near-completely (n=7, 35%). Partial regression was obtained in one patient (5%) and there was no regression in one patient (5%). No significant complications were encountered.

CONCLUSION

The holmium-166-chitosan complex seems to be useful as a new painless sclerosing agent for the treatment of renal cysts with no significant complications.

A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts

OBJECTIVES

To present the results of a minimally invasive treatment of symptomatic simple renal cysts, and to propose an algorithm for their management.

PATIENTS AND METHODS

Seventeen patients presenting with suspected symptomatic simple renal cysts were referred for trial aspiration; 16 presented with loin pain and one with a flank mass. If the cyst and symptoms recurred after a temporary response, they were managed by re-aspiration with sclerotherapy using 95% ethanol, or by laparoscopic de-roofing of the cyst.

RESULTS

Of the 17 patients referred, one failed to respond to aspiration and was excluded from further analysis. Three patients had sustained pain relief from simple aspiration alone, 13 required further treatment for symptom relapse, of whom six had aspiration and sclerotherapy, and seven had laparoscopic de-roofing. After a mean follow-up of 17 months, pain had recurred in all five patients originally presenting with pain and managed by sclerotherapy, and the patient who presented with a painless mass from a large cyst also developed pain after sclerotherapy. In contrast, the subsequent seven patients managed by laparoscopic treatment are pain-free at a mean follow-up of 17.7 months.

CONCLUSION

Evaluation including a diagnostic aspiration is essential to diagnose a symptomatic cyst. When treatment is indicated, laparoscopic de-roofing appears to be more effective than sclerotherapy.

Long-term results of multiple minocycline hydrochloride injections for the treatment of symptomatic solitary hepatic cyst

BACKGROUND

The current study presents the long-term results of multiple minocycline hydrochloride (MINO) injections for the treatment of symptomatic solitary hepatic cyst.

METHODS

From 1989 to 1998, nine patients were referred for the treatment of a symptomatic solitary hepatic cyst, comprising two males and seven females aged between 41-72 years (mean 58.2 years). The chief complaint in all cases was upper abdominal discomfort or pain. Mean cyst diameter was 14.1 +/- 2.3 cm. After insertion of an 8 or 9-French catheter into the cyst, 200 mg of MINO in 10 mL saline was injected and the catheter was flushed with 10 mL saline, for a total of 20 mL saline. The catheter was then clamped for 30 min. MINO injection was performed daily for 7-8 days, after which time the catheter was removed.

RESULTS

One patient complained of moderate right subscapular pain immediately after the injection, and one patient complained of pain at the site of catheter insertion. Patients were followed for 42-153 months (mean 85 months). Cyst regression without recurrence was documented in all patients.

CONCLUSIONS

Multiple injections of MINO are safe, definitive treatments for symptomatic solitary hepatic cyst.

Percutaneous sclerotherapy of a giant benign renal cyst with alcohol

We report a case of giant, benign renal cyst that was treated with percutaneous aspiration and sclerotherapy using 95% alcohol. A seven French catheter was inserted into the cyst under ultrasonographic and fluoroscopic guidance, and was then left in place to drain the cyst contents. Approximately 4 l of fluid was drained the first day. The following day, a gravity sinogram was obtained, which showed there were no connections between the cyst and the collecting system. The alcohol treatment involved repeated injections of decreasing amounts of alcohol, with volumes selected in accordance with follow-up sinograms. The patient's symptoms resolved and cyst drainage stopped after 3 successive days of therapy. Totally 600 ml alcohol has given. Follow-up ultrasound (US) and computed tomography (CT) studies showed no recurrent disease; with only a small remnant of the cyst wall. We encountered no major complications during follow-up.

Renal cystic disease. Laparoscopic management

Laparoscopy offers a safe and efficacious means of ablating symptomatic simple renal cysts while conferring the usual benefits of shorter hospital stay, quicker convalescence, and reduced postoperative pain, although no direct comparison with open surgery has been performed. For indeterminate, complex renal cysts, laparoscopic exploration may spare the patient a morbid open operation to assess a cystic lesion of indeterminant risk. Although laparoscopic removal of kidneys with ADPKD remains a technically challenging exercise, centers of laparoscopic expertise have demonstrated the safety and feasibility of the procedure, thereby expanding the benefits of laparoscopic surgery to patients traditionally relegated to open surgical management.

Percutaneous treatment of large symptomatic renal cysts

PURPOSE

To evaluate the efficacy of alcohol in combination with tetracycline for the treatment of symptomatic renal cysts.

PATIENTS AND METHODS

Twenty-four patients age 45 to 77 years (mean 66 years) with a large (5-13-cm; mean 7.5-cm) symptomatic renal cyst associated with flank pain were treated by aspiration under ultrasound guidance and injection of alcohol and tetracycline. Patients were followed with ultrasonography at 1, 6, and 12 months and once a year thereafter.

RESULTS

The aspirated volume ranged from 65 to 1500 mL (mean 360.5 mL). Two patients experienced mild pain during alcohol injection, but the procedure was completed successfully. One patient reported severe pain after tetracycline injection. The tetracycline was immediately aspirated, and the procedure was then aborted. The remaining patients were relieved of their symptoms after treatment, and they remained symptom free during a mean follow-up of 20 months (range 7-36 months).

CONCLUSIONS

The combination of alcohol and tetracycline is safe and effective and offers a very favorable minimally invasive therapeutic alternative for the treatment of symptomatic renal cysts.

Treatment of simple renal cysts by percutaneous drainage with three repeated alcohol injection

OBJECTIVES

This study sought to show the effectiveness and safety of three repeated alcohol injections for the treatment of simple large renal cysts.

METHODS

From September 1991 to December 1997 we treated 72 renal cysts. The cyst was drained with an 8F mono J stent. Ninety-five percent sterile ethanol was injected into the cyst and left in place for 20 minutes. Two repeat alcohol injections were performed every 24 hours. After the third alcohol injection, the catheter was removed. To avoid pain in the last 39 patients, 20 mL of 2% lidocaine hydrochloride was injected into the cyst for 15 minutes before the alcohol injections.

RESULTS

The follow-up period ranged from 8 to 83 months (mean 48). One patient underwent surgical intervention because of considerable bleeding in the cystic cavity that occurred after percutaneous drainage. In 1 patient in whom the cystic cavity communicated with the urinary tract, no alcohol injections were performed. After the repeated alcohol injections, the cystic cavity completely disappeared in 68 of the 70 treated cysts at first ultrasound examination. This result, observed at the first ultrasound control observation, remained unchanged during follow-up.

CONCLUSIONS

In our experience, percutaneous drainage with three repeated alcohol injections offers a high rate of success without the cost and morbidity associated with other procedures, such as operation or laparoscopy.

Percutaneous sclerotherapy of hydronephrosis in a non-functioning kidney

A 27-year-old woman was admitted with an abdominal mass in the right hypochondrium. Ultrasound, intravenous urography and scintigraphy revealed a giant non-functioning hydronephrosis. Because she refused surgery, a percutaneous aspiration with instillation of doxycycline was performed. One year thereafter, the patient was still without recurrence of any symptoms or hydronephrosis.

Infected renal cystic mass associated with bacterial meningitis: a case report

We report a case of an infected renal cystic mass associated with bacterial meningitis in a 70-year-old woman who had had poorly-controlled diabetes mellitus for approximately 30 years. She suffered from bacterial meningitis due to Klebsiella pneumoniae, which was successfully treated with antimicrobial chemotherapy for 1 month. Approximately 2 weeks later she developed left flank pain and a high fever. A CT scan and an ultrasonogram revealed a left renal cystic mass, which was considered to be an infected renal cyst. Turbid and thick fluid was obtained by percutaneous aspiration which contained numerous white blood cells. Culture of this fluid yielded K. pneumoniae. The bacterial meningitis was considered to be a secondary infection of the septicemia which resulted from the infected renal cystic mass.

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.