Sclerotherapy of a giant renal cyst with povidone-iodine

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

OBJECTIVES

To compare the efficacy and safety of ethanolamine oleate (EO) as a sclerosing agent, vs. absolute ethanol (AE), in the treatment of symptomatic simple renal cysts.

PATIENTS AND METHODS

Between November 2009 and October 2012, 46 patients were prospectively randomised into two groups. All patients presented with a simple renal cyst underwent ultrasonographic aspiration and injection of a sclerosing agent. In group 1, 25 patients had the cyst injected with EO, and in group 2, 21 were treated with AE. One injection was used in cysts of <200 mL and two injections were used in larger cysts. Complete and partial success were defined as complete cyst ablation or a >50% reduction in cyst volume with symptomatic relief, respectively. Patients were followed up using semi-annual ultrasonography and computed tomography for 2 years.

RESULTS

Sclerotherapy was technically successful in all patients. There was no significant difference in cyst volume between the groups. After ≈2 years of follow-up there was complete symptomatic relief in both groups, and the overall radiological success rate was 100% of both groups, at 79% complete and 21% partial in group 1, and 83% complete and 17% partial in group 2. The frequency of transient complications in the form of microscopic haematuria was 7% and 13%, and of low-grade fever in 4% and 10% in groups 1 and 2, respectively.

CONCLUSION

EO can replace AE as a sclerosing agent for symptomatic simple renal cysts, as it has comparable efficacy with higher safety and tolerance.

Value of ultrasound-guided irrigation and drainage of refractory pyocysts in ADPKD

Background

Cyst infections is not common in the patients with autosomal dominant polycystic kidney disease (ADPKD) however it may pose major problems to the clinicians because the diagnosis is hampered by lack of reliable imaging techniques for identification of the infected cysts and treatment may be difficult due to poor penetration of antibiotics into the cysts.

Case presentation

We present a case of ADPKD and intractable pyocysts that did not respond to standard antibiotic therapy but successfully treated by using ultrasound-guided cyst puncture, and repeated irrigation and drainage.

Conclusion

Where the experienced interventional radiologists are available, this method can rescue these patients from nephrectomy.

Alcoolização percutânea de cistos renais: revisão da literatura e apresentação de resultados

OBJETIVO: Demonstrar a eficácia e os resultados práticos da alcoolização percutânea de pacientes com cistos renais simples sintomáticos. MATERIAIS E MÉTODOS: Foram revistos os resultados obtidos em dez pacientes com cistos renais simples sintomáticos (oito homens e duas mulheres), com idade entre 28 e 72 anos (média de 55 anos), submetidos a pelo menos duas alcoolizações percutâneas. A indicação do procedimento foi dor no flanco refratária nos dez pacientes, sete deles com algum grau de hidronefrose pela localização parapiélica do cisto. O volume aspirado variou entre 20 e 1.300 ml (média de 200 ml). O tempo médio de seguimento após o procedimento foi de sete meses. O procedimento foi dirigido por ultrassonografia em dois casos e por tomografia computadorizada em oito. O tempo de internação variou entre 24 e 72 horas. Foi considerado sucesso completo do tratamento o desaparecimento do cisto, e parcial a redução maior que 50%. RESULTADOS: Durante o seguimento houve redução completa do cisto em sete pacientes e redução parcial em três. Em nenhum caso foram registradas complicações e os pacientes toleraram bem o procedimento. CONCLUSÃO: A alcoolização percutânea de cistos renais sintomáticos é um procedimento seguro, efetivo e pouco invasivo e com resultados semelhantes aos obtidos por outros autores.

Cyst ablation using a mixture of N-butyl cyanoacrylate and iodized oil in patients with autosomal dominant polycystic kidney disease: the long-term results

Objective

We wanted to assess the long-term results of cyst ablation with using N-butyl cyanoacrylate (NBCA) and iodized oil in patients with autosomal dominant polycystic kidney disease (ADPKD) and symptomatic cysts.

Materials and Methods

Cyst ablation using a mixture of NBCA and iodized oil was performed in 99 cysts from 21 patients who had such symptoms as abdominal distension and pain. The collapse or reaccumulation of the ablated cysts after the procedure was assessed during the follow-up period of 36 to 90 months. The treatment effects, including symptom relief, and the clinical data such as the blood pressure and serum creatinine levels were also assessed, together with the complications.

Results

The procedure was technically successful in all 99 cysts from the 21 patients. Any procedure-related significant complications were not detected. Seventy-seven of 99 cysts (78%) were successfully collapsed on the follow-up CT. Twenty-two cysts showed reaccumulation during long-term follow-up period. The clinical symptoms were relieved in 17 of the 21 patients (76%). Four of 12 patients (33%) with hypertension and two of six patients (33%) with azotemia were improved. End stage renal disease (ESRD) occurred in six of the 21 patients (28%) during the follow-up period. The mean age of ESRD in our patients was 57 years. The mean time interval for the development of ESRD was 19 months.

Conclusion

Ablation using a mixture of NBCA and iodized oil may be an effective, safe method for obtaining symptom relief in patients with ADPKD.

Percutaneous Sclerotherapy of Giant Benign Renal Cyst

We report a case of giant benign renal cyst that was treated with percutaneous aspiration and sclerotherapy using 95% alcohol. A 8F catheter was inserted into the cyst under ultrasonographic (US) guidance, and was then left in place to drain the cyst contents (approximately 4 L). A gravity sinogram showed no connections between the cyst and the collecting system. The alcohol treatment involved repeated injections of decreasing amounts of alcohol according with US measurement of cystic volume. The patient's symptoms resolved and cyst drainage stopped after 3 successive days of therapy. Follow-up ultrasound studies showed a 3.5 cm residual cystic wall only.

Ablation of symptomatic cysts using absolute ethanol in 11 patients with autosomal-dominant polycystic kidney disease

Objective

To evaluate the effects of cyst ablation with absolute ethanol in autosomal-dominant polycystic kidney disease (ADPKD) patients with symptomatic cysts.

Materials and Methods

Using absolute ethanol, cyst ablation was performed in 11 patients with documented ADPKD who suffered cyst pain refractory to medical treatment. An ethanol solution was instilled into the largest symptomatic cysts through a catheter. We assessed the therapeutic efficacy of the procedure by tracking subjective pain relief during a 3 to 24-month follow-up period after ablation.

Results

At follow-up, we found that the duration of subjective pain relief was 12 to 24 months in seven patients, 4 to11 months in one, and less than 3 months in three.

Conclusion

Selective ablation of a symptomatic cyst may be a valid option in managing chronic pain caused by one or a few large cysts in ADPKD patients.