Preliminary results of percutaneous treatment of renal cysts with povidone-iodine sclerosis

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.

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.

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.

Percutaneous sclerotherapy of cystic lesions

With modern cross-sectional imaging techniques, cystic lesions are very common and usually incidental findings, especially if small. However, when cysts enlarge, become infected, bleed, or undergo torsion, they can be symptomatic, and percutaneous drainage can be effective in the management. When cysts recur after aspiration, which is often the case for hepatic and renal cysts, cyst sclerosis or surgical unroofing may be required. This article describes the indications for and technical aspects of percutaneous sclerotherapy of cystic lesions of multiple organ systems.

Percutaneous unroofing of renal simple cysts: Experience from one centre

OBJECTIVE

To assess the efficacy of percutaneous unroofing (PU) for treating simple renal cysts, compared with laparoscopic decortication and open surgery.

PATIENTS AND METHODS

From November 2009 to October 2010, 11 patients with 12 simple cysts in renal units were managed by PU. All cysts were evaluated with ultrasonography and abdominal computed tomography. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterised. A drain was left in place for 2 days. Success was defined as a >50% reduction in cyst diameter.

RESULTS

At the 5-month follow-up, patients were asked about their symptoms and assessed by ultrasonography. Of the 12 cyst units, eight were completely resolved, three were reduced to <50% in diameter and one was persistent, close to the original size.

CONCLUSION

Simple renal cysts can be managed safely by PU, with a success rate of >90%. This technique offers several advantages over open surgery, with a shorter hospital stay, improved convalescence and reduced risk of complications. PU also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy.

Renal cysts and urinomas

Renal cysts are a common imaging finding. Although most cysts never have symptoms, some cause pain, collecting system compression, hematuria, hypertension, and secondary infection. The mere presence of a cyst is not an indication for intervention, but treatment may be indicated in symptomatic patients or those with secondary obstruction. Urinomas generally are a contained collection of urine outside of the normal pathways where urine travels. As such, urinomas can arise anywhere from the upper abdomen down into the low pelvis and have a variety of etiologies. Ureteral obstruction with forniceal rupture and trauma (blunt, penetrating, or iatrogenic) are the most common causes of urinomas. When urinomas arise spontaneously, the likely cause varies with the patient's age. Blunt or penetrating trauma can cause perinephric urinomas by two mechanisms-direct disruption of the pelvis or collecting system or by degeneration of nonviable tissue. These urinomas are often perinephric, but can also occur in a subcapsular location. This review will discuss diagnosis, classification, and treatment of renal cysts and urinomas.

Percutaneous decortication of cystic renal disease

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.

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.

Simple renal cyst sclerotherapy with acetic acid: our 10-year experience

BACKGROUND AND PURPOSE

The combination of percutaneous aspiration and sclerotherapy is an effective method for managing benign renal cysts. Many substances have been used as sclerosing agents. Here, we report the long-term outcome after simple renal cyst sclerotherapy with acetic acid.

MATERIALS AND METHODS

We retrospectively reviewed medical records and identified 60 cases of renal cysts that were managed with percutaneous sclerotherapy from June 1998 to December 2007. All patients were followed up with ultrasonography. We divided the treatment results into three groups: Complete regression (<10%), partial regression (11%-50%), and no response (>51%).

RESULTS

The mean volume of the renal cysts on presclerotherapy images was 244 mL (range 12-1216 mL), the mean volume of the aspirate was 233 mL (range 10-1450 mL), and the mean volume of acetic acid administered was 34.6 mL (range 4-100 mL). The median follow-up period was 10 months (range 3-84 months); 46 cases exhibited complete regression (76.7%); 12, partial regression (20.0%); and 2, no response (3.3%). The complications were local pain (nine cases, 15.0%) and nausea and/or vomiting (three cases, 5.0%).

CONCLUSIONS

The results reveal that acetic acid as a sclerosing agent exhibits a high long-term success rate even at a low dose and produces few complications during the procedure. Thus, we suggest that sclerotherapy with acetic acid offers a more effective management option.

Alcohol sclerotherapy in the treatment of symptomatic simple renal cysts

The aim of this study was to evaluate the results of percutaneous drainage with single-session alcohol sclerotherapy in the treatment of symptomatic simple renal cysts. Thirty patients (16 men and 14 women, average age 54,7+/-11,3 years) with simple renal cysts were treated by ultrasound guided percutaneous aspiration and single-session alcohol sclerotherapy. Patient demographics, clinical characteristics, treatment outcome and complications were analyzed. Average reduction of cyst volume was 91,2%. Complete and partial resolution occurred in 10 (33%) and 14 (47%) cysts, respectively. Six cases were defined as failure with reduction of cyst volume <80%. Flank pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 8 patients. The hospital stay was one day for all patients. Treatment of simple renal cysts is indicated when the cysts are sufficiently large and cause complaints or when associated with complications. Percutaneous treatment with alcohol sclerotherapy of benign renal cysts can be performed safely and effectively.

Symptomatic simple renal cyst: comparison of continuous negative-pressure catheter drainage and single-session alcohol sclerotherapy

OBJECTIVE

The purpose of this study was to evaluate whether continuous percutaneous catheter drainage with negative pressure yields better results than single-session alcohol sclerotherapy in the management of symptomatic simple renal cysts.

SUBJECTS AND METHODS

Eighty-five patients with 92 simple renal cysts were randomly assigned to two groups in a prospective controlled trial. One group was treated with sonographically guided continuous catheter drainage with negative pressure and the other group with single-session alcohol sclerotherapy. Patient demographics, clinical characteristics, treatment outcome, and complications were analyzed.

RESULTS

The initial volume of the cysts did not differ significantly between the groups, but the final volume was significantly smaller in the continuous drainage group (p = 0.026). During the 24-month follow-up period, 37 (40%) of the cysts disappeared completely: 24 (52%) of the 46 cysts in the drainage group and 13 (28%) of the 46 cysts in the sclerotherapy group (p = 0.033). In the sclerotherapy group, the probability of disappearance of the cysts was highly dependent on cyst size, being less for giant cysts (p = 0.01). Cyst size was not a significant factor in probability of disappearance in the drainage group (p = 0.15). The probability of disappearance of giant cysts (volume > 500 mL) differed significantly between the groups (p = 0.009), but there was no difference in probability of disappearance of moderately large cysts (p = 0.16). Three of 14 patients with giant cysts in the drainage group and 10 of 13 such patients in the sclerotherapy group had recurrences that necessitated additional treatment (p = 0.007). They were successfully treated with continuous catheter drainage.

CONCLUSION

Continuous catheter drainage with negative pressure is more efficient than single-session alcohol sclerotherapy in the management of giant cysts. For moderately large cysts, the two methods have similar results.

Efficacy of single-session percutaneous drainage and 50% acetic Acid sclerotherapy for treatment of simple renal cysts

PURPOSE

To evaluate the efficacy and long-term results of single-session 50% acetic acid sclerotherapy for the treatment of simple renal cysts, and to compare the therapeutic results of 5 and 20 min sclerosant dwell techniques.

METHODS

During the past 9 years, 50% acetic acid sclerotherapy was performed on 67 cysts in 66 patients. An acetic acid volume corresponding to a mean of 23% of the aspirated cyst volume was injected into the cysts. A 20 min dwell time with position changes was performed in 32 cysts (31 patients; group I) and 8% of volume for a 5 min dwell time in 35 cysts (35 patients; group II). Three- and 6-month sonographic or CT follow-up was performed for a minimum of 1 year. Complete regression was defined as no remaining cyst measurable on sonography with or without a scar at the renal cortex. Partial regression was defined as a decreased cyst volume compared with that before sclerotherapy. The Mann-Whitney U-test was used to compare the therapeutic results between the two groups.

RESULTS

For 67 simple renal cysts, complete regression on follow-up was observed in 21 of 32 cysts (66%; group I) and 22 of 35 cysts (63%; group II); the remaining 24 cysts all showed partial regression. The partial reduction rate of the cyst's volume was 97.4% (91.3-99.4%) in group I and 96.9% (90.8-99.5 %) in group II. There were no procedure-related major complications, and no statistically significant differences in the complete regression and partial volume reduction rates between the two groups (p > 0.05).

CONCLUSION

Fifty percent acetic acid is an effective and safe sclerosing agent for simple renal cysts. Fifty percent acetic acid sclerotherapy with a 5 min sclerosant dwell time, using a volume of about 10% of the aspirated volume, is sufficient for satisfactory results of simple renal cyst sclerotherapy.

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.

Povidone-iodine sclerotherapy is ineffective in the treatment of symptomatic renal cysts

PURPOSE

To evaluate the efficacy of povidone-iodine sclerotherapy after percutaneous drainage of simple renal cysts in the treatment of symptomatic patients.

PATIENTS AND METHODS

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).

RESULTS

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.

CONCLUSION

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 symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy

OBJECTIVE

To report our experience with the use of 95% ethanol as sclerotherapy for symptomatic simple renal cysts.

PATIENTS AND METHODS

Sixty patients with 64 symptomatic simple renal cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of 95% ethanol (31 men and 29 women, mean age 46 years, SD 22). The main presentation was renal pain in 34 patients, renal mass in nine, hypertension in 11 and haematuria in six; 24 cysts were on the right, 32 on the left and four bilateral. Patients were evaluated after 1 month and then every 6 months by clinical assessment, US and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume with the resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume and/or persistent symptoms.

RESULTS

After aspiration and ethanol sclerotherapy, there was microscopic haematuria in two patients and low-grade fever (<38.3 degrees C) in two, but no major complications. During a mean (range) follow-up of 19 (14-40) months there was complete cyst ablation in 54 cysts and partial resolution in 10. Pain disappeared or was much improved in all patients. After cyst ablation hypertension was well controlled with no medication in all 11 hypertensive patients and haematuria disappeared in all six affected patients.

CONCLUSIONS

Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive and highly effective. We recommend it as the first therapeutic option in these patients.

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.

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.

Percutaneous Drainage of Simple Cysts of the Kidney: A New Method

OBJECTIVE

The experience of our department on the treatment of solitary simple kidney cysts with continuous percutaneous drainage for 24 h and instillation of pure alcohol as a sclerotic agent is reported. The results are compared with those of previous years when the treatment consisted of percutaneous drainage and injection of pure alcohol.

PATIENTS AND METHODS

During the period 1992-2001, 252 patients (136 male, 116 female; aged 22-74 years) were treated at our department, and all had a solitary kidney cyst. They were treated by percutaneous drainage and then injection of pure alcohol for 20 min via a nephrostomy tube (which remained in position for 24 h). The mean follow-up period was 5 years. This cohort of patients was compared to another one of 238 patients who were treated with a previous method (126 male, 124 female; aged 28-79 years, mean 59 years).

RESULTS

In 71% of the patients the symptoms and the cyst both disappeared, in 22% there was no significant recurrence (i.e. cyst diameter <5 cm), and the remaining 7% presented significant recurrence (i.e. cyst diameter >5 cm). Most of the latter cases were treated again using the same method. Of the 73 patients with impaired kidney function, in 61 (83%) this appeared to have improved as a result of our treatment. Of the 61 patients with hypertension, in 29 (47%) this appeared to have improved. There was only 1 case with complications, which presented purulence of the cyst that required open surgery. In previous case series, which were treated with percutaneous drainage and injection of pure alcohol just after the puncture of the cyst--without continuous drainage of the cyst for 24 h--only 10% of the patients had no recurrence, 30% had no significant recurrence (volume of the cyst <20% of the pre-operative volume), and 60% of the patients had significant recurrence (volume of the cyst >20% of the pre-operative volume).

CONCLUSIONS

Percutaneous drainage of solitary kidney cysts for 24 h followed by injection of pure alcohol, as a sclerotic agent, is an effective therapeutic method with only a few complications. It was therefore considered being the proffered method for the treatment of solitary kidney cysts.

Laparoscopic Ablation of Giant Renal Cyst

We report a case of a symptomatic giant (18 x 10 x 8-cm) renal cyst in a 40-year-old woman that was marsupialized laparoscopically and excised. The surgical technique, based on progressive decompression of the cyst, is fully described. Excellent results were achieved. The recent application of laparoscopic ablation of different types of renal cysts is reviewed. This minimally invasive technique, when properly mastered, is highly effective and offers results similar to those of open surgery. It is associated with definitive postoperative advantages and is the treatment of choice for very large renal cysts, especially those located anteriorly, when sclerotherapy is ineffective or is contraindicated.

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.

Renal cyst ablation with n-butyl cyanoacrylate and iodized oil in symptomatic patients with autosomal dominant polycystic kidney disease: preliminary report

Fifty renal cysts in 14 patients with autosomal dominant polycystic kidney disease (ADPKD) were treated with percutaneous needle aspiration and intracystic injection of a mixture of n-butyl cyanoacrylate and iodized oil in a ratio of 1:2. At follow-up of 1-12 months, symptoms improved in 12 (86%) of 14 patients, and 25 (81%) of 31 cysts decreased more than 50% in diameter. This procedure appears to be feasible and may be an effective modality in ablation of renal cysts in patients with ADPKD.

Marsupialization and iodine sclerotherapy of a branchial cyst in a horse

A 6-month-old Morgan colt was evaluated because of a 10-cm right-sided retropharyngeal swelling. The swelling was soft and moveable on examination, and palpation did not elicit signs of pain. Radiography revealed a large space-occupying mass ventral to the second cervical vertebra; ultrasonography revealed an anechoic fluid-filled structure with a well-defined hyperechoic capsule. Fine-needle aspiration yielded a viscous amber fluid. Cytologic evaluation indicated that the fluid was an exudate; anaerobic and aerobic bacterial culture did not yield any growth. Histologic examination of a portion of the cyst capsule revealed a connective tissue wall lined by pseudostratified columnar to cuboidal epithelium, consistent with a branchial cyst. The cyst wall was marsupialized to the skin, and iodine sclerotherapy was performed twice daily for 14 days, at which time forceps were introduced into the cyst and the cyst lining was removed. The site was allowed to heal by second intention, but 10 days later, the swelling recurred. An incision was made over the previous marsupialization site, and residual remnants of the cauterized cyst lining were removed with a forceps. The foal did not have any other complications during the subsequent 2 years. Branchial arch cysts are uncommon embryonic anomalies of horses, mice, cats, dogs, and cattle. Results suggest that marsupialization and iodine sclerotherapy may be a viable alternative to surgical excision in horses with branchial cysts; however, the entire cyst lining must be removed at the completion of sclerotherapy to prevent recurrence and abscess formation.