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Kim MG, Kim TM, Kim SY, Cho JY. Prediction of treatment response following ethanol sclerotherapy of renal cysts by computed tomography. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3563-3573. [PMID: 35913507 DOI: 10.1007/s00261-022-03621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate predictive factors of treatment response following ethanol sclerotherapy of large renal cysts via computed tomography (CT). METHODS Retrospective study reviewed 71 patients (61.0 ± 13.2 years; M:F = 32:39) who underwent pretreatment CT and were treated with sclerotherapy of a large (> 5 cm) renal cyst (mean volume: 279.8 cc) using 99% ethanol from January 2010 to February 2019. Patients were followed up at least two times, short-term (defined as < 6 months, median 2.1 months) and long-term (defined as > 1 year, median 15.5 months), via ultrasound or CT. Suboptimal response was defined as the volume of residual cyst > 20 mL in each follow-up. Predictive variables of radiologic findings and radiomics features were analyzed using logistic regression analysis. RESULTS Suboptimal response rates were 33.8% and 18.3% at short-term and long-term follow-ups, respectively. In radiologic findings, patients with suboptimal response in the short-term follow-up showed a more frequent estimated cyst volume ≥ 270 mL (OR 14.8, 95% CI 3.9-55.9, p < 0.001) and sinus protrusion (OR 7.0, 95% CI 1.7-28.5, p = 0.007). Cyst volume ≥ 270 mL was also associated with suboptimal response in the long-term follow-up (OR 4.6, 95% CI 1.3-16.9, p = 0.021). When radiomics features were combined, the area under the curve increased from 0.83 to 0.86 and from 0.68 to 0.82 to predict suboptimal response in short-term and long-term follow-ups, respectively. CONCLUSION Greater estimated volume, sinus protrusion, and radiomics features of the cysts in pretreatment CT can help predict suboptimal response of renal cyst after sclerotherapy.
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Affiliation(s)
- Min Gwan Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 03080, Korea
| | - Taek Min Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 03080, Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 03080, Korea
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2
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Patel NJ, Brady R, Scharf VF. Single-Incision Laparoscopic Deroofing and Omentalization of a Cystic Renal Adenoma in a Dog. J Am Anim Hosp Assoc 2021; 56:331. [PMID: 33113559 DOI: 10.5326/jaaha-ms-6991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/11/2022]
Abstract
A 12 yr old 13.5 kg male castrated Pembroke Welsh corgi was presented for evaluation of a suspected renal cyst following multiple episodes of lethargy and abdominal pain. Abdominal imaging revealed a large, thin-walled, hypoechoic cystic lesion associated with the cranial pole of the left kidney and a second smaller cystic lesion on the caudal pole. The larger cystic lesion was repeatedly drained percutaneously, but the lesion returned to initial size and clinical signs returned within weeks. Percutaneous ethanol sclerotherapy achieved only transient improvement in lesion size and abdominal discomfort. Laparoscopic deroofing and omentalization of the larger left renal cystic lesion was performed. The resected cystic wall was histopathologically consistent with a renal adenoma. Abdominal ultrasonography performed 1 mo postoperatively found no recurrence of the cystic renal adenoma. Repeated ultrasonography at 3 mo postoperatively detected a small cystic lesion at the cranial pole of the left kidney, which remained static in appearance at 11 and 18 mo postoperatively. During all follow-up visits, the dog was reported to be doing well with no recurrence of clinical signs. Renal cysts causing clinical signs and renal adenomas are rare in veterinary medicine; laparoscopic deroofing and omentalization provides a minimally invasive treatment approach.
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Affiliation(s)
- Nikesh J Patel
- From the College of Veterinary Medicine (N.J.P.) and Department of Clinical Sciences (V.F.S.), North Carolina State University, Raleigh, North Carolina; and Department of Surgical and Radiological Sciences, University of California Davis, Davis, California (R.B.)
| | - Rachel Brady
- From the College of Veterinary Medicine (N.J.P.) and Department of Clinical Sciences (V.F.S.), North Carolina State University, Raleigh, North Carolina; and Department of Surgical and Radiological Sciences, University of California Davis, Davis, California (R.B.)
| | - Valery F Scharf
- From the College of Veterinary Medicine (N.J.P.) and Department of Clinical Sciences (V.F.S.), North Carolina State University, Raleigh, North Carolina; and Department of Surgical and Radiological Sciences, University of California Davis, Davis, California (R.B.)
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3
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Zhou G, Li S, Jiang M, Zhou W, Yin J. Comparison of polidocanol sclerotherapy with laparoscopic deroofing in the management of pediatric symptomatic simple renal cysts: A long-term study. J Endourol 2021; 36:99-103. [PMID: 34269606 DOI: 10.1089/end.2021.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of percutaneous polidocanol sclerotherapy and laparoscopic deroofing in the management of pediatric symptomatic simple renal cysts. METHODS Forty-six patients with symptomatic simple renal cysts (cyst size ≥ 4 cm) were treated either with polidocanol sclerotherapy (group A) or by laparoscopic deroofing (group B) between December 2009 and October 2019. The patients were re-evaluated at 1, 6, and 12 months and annually thereafter. RESULTS Twenty-one patients were treated with polidocanol sclerotherapy (group A) and 25 patients with laparoscopic deroofing (group B). The mean follow-up period was 58.7 months (14-107) in group A and 57.2 months (12-118) in group B. Complete regression was seen in 19 (90.5%) and 24 (96%) patients in groups A and B, respectively (p<0.05). Partial regression was documented in one patient each in group A (4.8%) and B (4%). In one group A patient, a laparoscopic deroofing was performed due to sclerotherapy failure after 27 months. The operation time, postoperative hospital stay, and cost were significantly less in group A than in group B (36.3±8.4 vs. 96.9±19.1, 19.7±2.4 vs. 56.0±8.6, and ¥8173±1343 vs. ¥14119±2021, respectively; p < 0.05). CONCLUSION Polidocanol sclerotherapy and laparoscopic deroofing were found to be equally effective interventions associated with minimal complications for pediatric symptomatic simple renal cysts. We recommend polidocanol sclerotherapy as the first option for children with symptomatic simple renal cysts and laparoscopic deroofing in cases of failed polidocanol sclerotherapy.
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Affiliation(s)
| | | | | | | | - Jianchun Yin
- Shenzhen Children's Hospital, 85113, urology, Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, P.R.China, Shenzhen, China, 518038;
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4
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Gu P, Li M, Zhang M, He X. Effect of body mass index on the operation time and postoperative hospital stay of retroperitoneal laparoscopic renal cyst decortication. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hong Y, Chen X, Wu M, Xi H, Hu J. Percutaneous versus Laparoscopic treatment for simple renal cysts: a meta-analysis. J Endourol 2021; 35:1793-1800. [PMID: 34036798 DOI: 10.1089/end.2021.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the percutaneous and laparoscopic treatment for renal cyst in order to determine the optimal therapy for patients with renal cyst. METHODS A systematic search of PubMed, Cochrane Library, Web of Science, and EMBASE databases was conducted for articles published through Jun 3, 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS We found 493 studies form databases, and 6 were considered for the evidence synthesis. A total of 1631 cases were included. Of these patients, 488 cases undergone laparoscopic treatment, and 1143 cases undergone percutaneous treatment. Symptomatic and radiologic success were higher for laparoscopic treatment (odd ratio, OR, OR=3.59, 95% confidence interval, CI, 1.45-8.88, P=0.006; and OR=7.46, 95% CI 3.99-13.94, P<0.00001, respectively). Minor or severe complications were similar between the two treatments (OR=1.54, 95% CI 0.40-5.98, P=0.53; OR=3.13, 95% CI 0.03-359.76, P=0.64, respectively). CONCLUSION Laparoscopic treatment for renal cyst was associated with better symptomatic and radiologic success, and its complication was no more than percutaneous treatment.
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Affiliation(s)
- Yanyan Hong
- First Affiliated Hospital of Nanchang University, 117970, Nursing, Nanchang, China;
| | - Xinpeng Chen
- First Affiliated Hospital of Nanchang University, 117970, Nanchang, China;
| | - Mengjun Wu
- The People's Hospital of Yongxiu County, urology, Yichun, China;
| | - HaiBo Xi
- First Affiliated Hospital of Nanchang University, 117970, urology, Nanchang, Jiangxi, China;
| | - Jieping Hu
- First Affiliated Hospital of Nanchang University, 117970, urology, nanchang, Nanchang, China, 330006.,First Affiliated Hospital of Nanchang University, 117970, urology, yongwaizheng road, Nanchang, China, 330006;
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Maugeri A, Fanciulli G, Barchitta M, Agodi A, Basile G. Comparison of aspiration with sclerotherapy and laparoscopic deroofing for the treatment of symptomatic simple renal cysts: a systematic review and meta-analysis. Updates Surg 2021; 73:1691-1698. [PMID: 33796981 PMCID: PMC8500865 DOI: 10.1007/s13304-021-01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022]
Abstract
There are currently several strategies for the treatment of symptomatic simple renal cysts, such as aspiration with sclerosants and laparoscopic deroofing. However, no clear indication exists for choosing between them. Here, we carried out a systematic review and a meta-analysis of studies, which compared symptomatic and radiological success between aspiration with sclerotherapy and laparoscopic deroofing. Results were reported as relative risk (RR) and 95% confidence interval (95% CI) using laparoscopic deroofing as control group. The symptomatic and radiological successes were evaluated by 6 and 3 studies, respectively. Notably, aspiration with sclerotherapy was associated with higher risk of failure than laparoscopic deroofing (RR = 2.82; 95% CI = 1.84–4.31 for symptomatic failure; RR = 8.31; 95% CI = 4.22–16.38 for radiological failure). On the other hand, however, aspiration with sclerotherapy was associated with less frequent complications, shorter treatment duration and post-treatment hospital stay, and lower costs. Thus, our work underlines benefits and drawbacks of each intervention, raising the need for further studies to design guidelines for the management of simple renal cysts.
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Affiliation(s)
- Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123, Catania, Italy
| | - Gabriele Fanciulli
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, via S. Sofia, 78, 95123, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia 87, 95123, Catania, Italy.
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, via S. Sofia, 78, 95123, Catania, Italy.
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Chen H, Li Y, Zeng F, He C, Cui Y, Chen J, Zeng H, Lu S, Wang W, Chen Z. Percutaneous nephrostomic decortication: a microinvasive surgery for posterior renal cyst. Transl Androl Urol 2020; 9:2764-2770. [PMID: 33457248 PMCID: PMC7807317 DOI: 10.21037/tau-20-875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To assess the safety, feasibility, and efficacy of a modified process we developed in order to perform decortication surgeries for simple renal cysts through a percutaneous approach, 18 patients with simple renal cysts larger than 5 cm were treated with our new technique, from November 2016 to January 2019. All of the cysts were evaluated with ultrasonography and contrast-enhanced computed tomography. The Surgical procedure: as the standard mini-Percutaneous Nephrostomy procedure, a puncture was made directly into the cyst through the cyst roof under ultrasound guidance. After the inner cyst wall examination, the sheath was then retracted to just outside the cyst roof. The sheath together with the scope was used to detach the roof from the perirenal fat, after which the cyst roof was resected using a laser. A drain tube was left in the retroperitoneal space for 1-2 days. Subsequently, all patients were discharged 1 to 2 days post-surgery. Skin incision was less than 1 cm. No major complication was observed. The follow-up time ranges from 14 to 37 months. One case had an incompletely resected cyst with the cyst volume being decreased by more than 60%. This patient didn't receive any additional treatments during his follow-up. For all the other patients, the cysts had completely disappeared and no relapse had occurred. In conclusion, in the selected patients with a simple posterior renal cyst, our new technique is a safe and an effective option. It is also considered the least invasive decortication surgery for posterior renal cyst.
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Affiliation(s)
- Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Huimin Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Siqi Lu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Weiguo Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Bertog S, Sharma A, Mahfoud F, Pathak A, Schmieder RE, Sievert K, Papademetriou V, Weber MA, Haratani N, Lobo MD, Saxena M, Kandzari DE, Fischell TA, Sievert H. Alcohol-Mediated Renal Sympathetic Neurolysis for the Treatment of Hypertension: The Peregrine™ Infusion Catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 24:77-86. [PMID: 32958438 DOI: 10.1016/j.carrev.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/15/2020] [Accepted: 09/01/2020] [Indexed: 01/12/2023]
Abstract
Renal sympathetic denervation using conventional non-irrigated radiofrequency catheters has potential technical shortcomings, including limited penetration depth and incomplete circumferential nerve damage, potentially impacting therapeutic efficacy. Against this background, second generation multi-electrode, radiofrequency and ultrasound renal denervation systems have been developed to provide more consistent circumferential nerve ablation. Irrigated catheters may allow deeper penetration while minimizing arterial injury. In this context, catheter-based chemical denervation, with selective infusion of alcohol, a potent neurolytic agent, into the perivascular space, may minimize endothelial, intimal and medial injury while providing circumferential neurolysis. Animal studies demonstrate pronounced renal norepinephrine level reductions and consistent renal nerve injury after perivascular alcohol infusion using the Peregrine Catheter. Early clinical studies demonstrated significant blood pressure reductions and a reasonable safety profile. Randomized sham-controlled trials (NCT03503773, NCT02910414) are underway to examine whether the aforementioned theoretical advantages of alcohol-medicated denervation with the Peregrine System™ Kit translate into clinical benefits.
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Affiliation(s)
- Stefan Bertog
- CardioVascular Center Frankfurt, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Felix Mahfoud
- Saarland University Hospital, Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Homburg/Saar, Germany; Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco
| | - Roland E Schmieder
- University Hospital of the Friedrich Alexander University Erlangen-Nürnberg, Germany
| | - Kolja Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Johannes Gutenberg Universität, Mainz, Germany
| | | | | | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | | | | | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, UK.
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9
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Abstract
Objective: To investigate the assessment of feasibility and safety of laparoscopic decortication of simple renal cysts in elderly patients.Methods: The data of 114 patients who underwent laparoscopic decortication for simple renal cyst between October 2011 and May 2019 were retrospectively evaluated. Patients' age, gender and ASA scores; operation time; cyst size and location; complications; hospital stays and success rates of operations were recorded.Results: The mean age of the patients were 73.8 ± 8.2 years. Forty-eight (42.1%) of the patients were female and 66 (57.9%) were male. Cysts were localized on the right side in 61 (53.5%) patients and on the left side in 53 (46.5%) patients; and mean cyst size was 72.83 ± 31.13 mm. Also, they were localized on the anterior in 88 (77.2%) patients and on the posterior of the kidney in 26 (22.8%) patients. Preoperative ASA score distributions were ASA-I in 12 patients (10.5%), ASA-II in 31 patients (27.2%), ASA-III in 68 patients (59.7%), and ASA-IV in 3 patients (2.6%). Mean operative time was 41.4 ± 5.6 min. Clavien grade 1 complications were observed in 5 (10.4%) patients. Median hospitalization time was 1 day. No recurrence was occurred in any patient in the postoperative period.Conclusions: Although laparoscopic surgery has some risks and complications for elderly patients, laparoscopic decortication can be applied safely and effectively in treatment of simple renal cyst in that patient population.
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Affiliation(s)
- Ali Akkoç
- Department of Urology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Cemil Aydın
- Department of Urology, Faculty of Medicine, Hitit University, Corum, Turkey
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10
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Zhang X, Cao D, Han P, Ren Z, Wang J, Wei Q. Aspiration-sclerotherapy versus laparoscopic de-roofing in the treatment of renal cysts: which is better? BMC Nephrol 2020; 21:193. [PMID: 32448166 PMCID: PMC7245882 DOI: 10.1186/s12882-020-01832-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To compare the clinical efficiency between aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) in the management of renal cysts through meta-analysis of comparative studies. METHOD A comprehensive literature search was performed by PubMed, MEDLINE, Ovid and Web of Science for relevant studies published up to January 2020. The statistical analyses were conducted with Review Manager 5.3.0 and Stata 15.1. The sensitivity analysis was also carried out to confirm the reliability of this Meta-analysis. RESULTS Our searches of literature generated 6 studies (1547 patients incorporated) comparing AS with LD in the impacts of renal cyst therapy. Of these, 6 studies contained 1106 and 441 patients who were treated with AS and LD, respectively. The outcome of this meta-analysis indicated that LD group was superior in symptomatic successful rate [Odds Ratio (OR): 0.28; 95%Confidence Interval (CI): 0.09 to 0.86; P = 0.03), radiological successful rate (OR: 0.06; 95%CI: 0.02 to 0.15; P < 0.01) and recurrence rate (OR: 6.08; 95%CI: 2.81 to 13.15; p < 0.01). Nevertheless, AS group had shorter treatment time [Mean Difference (MD):-51.10; 95% CI:-73.01 to - 29.20; p < 0.01]. No statistically significant difference was showed in the rate of complications (OR: 3.19; 95% CI: 0.39 to 25.88; P = 0.28). CONCLUSIONS In our meta-analysis, LD had higher symptomatic successful rate, radiological successful rate as well as lower recurrence rate than AS, while the treatment time was longer.
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Affiliation(s)
- Xueling Zhang
- Department of Urology, West China Hospital, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, West China Hospital, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 61000, People's Republic of China
| | - Peizhen Han
- Department of Urology, West China Hospital, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
| | - Zhengju Ren
- Department of Urology, West China Hospital, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
| | - Jia Wang
- Department of Urology, West China Hospital, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China.
| | - Qiang Wei
- Department of Urology, West China Hospital, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China.
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11
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Han X, Yuan G, Zhu X, Li T, Li Y, Zhang P, Zhang X, Yang B, Yin G. A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts. MINIM INVASIV THER 2020; 30:179-186. [PMID: 32281887 DOI: 10.1080/13645706.2019.1699835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This study aimed to investigate the safety and efficacy of mini-laparoscopy for renal cyst unroofing. MATERIAL AND METHODS Eighty-six patients for treatment of renal cysts that met the selection criteria were included in this study. They were divided into two groups. Forty-five patients underwent cyst unroofing via mini-laparoscopy (Group M), and 43 patients underwent cyst unroofing via standard laparoscopy (Group S). There were no differences between the two groups in terms of sex, age, body mass index or clinical data. Data from the groups were recorded and analyzed. RESULTS The average hospital stays were shorter (p = .039) and postoperative painkiller demand was lower (p = .031) in Group M than in Group S. Forty-one out of 45 procedures in Group M were successful, and all 43 cases in Group S were successfully. With a follow-up period of 0.5 to 5.5 years, there was no significant difference in recovery rate (p = .213). Questionnaires showed that patients in Group M were significantly more satisfied with their cosmetic results than were patients in Group S (p = .041). CONCLUSION Our findings suggest that renal cyst decortications with mini-laparoscopic instruments are as safe and effective as procedures using standard laparoscopic instruments. Cosmetically, the results are better with mini-laparoscopy than with standard laparoscopic unroofing.
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Affiliation(s)
- Xiuwu Han
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Guangtong Yuan
- Department of Urology, People's hospital of Suning County, Suning, P. R. China
| | - Xuhui Zhu
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Tao Li
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Yansheng Li
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Peng Zhang
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xin Zhang
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Baoshen Yang
- Department of Urology, People's hospital of Suning County, Suning, P. R. China
| | - Genmin Yin
- Department of Urology, People's hospital of Suning County, Suning, P. R. China
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Esposito C, Soria-Gondek A, Castagnetti M, Cerulo M, Del Conte F, Esposito G, Pecoraro C, Cicala D, Farina A, Escolino M. Laparoscopic or Robotic Deroofing Guided by Indocyanine Green Fluorescence and Perirenal Fat Tissue Wadding Technique of Pediatric Simple Renal Cysts. J Laparoendosc Adv Surg Tech A 2020; 30:471-476. [PMID: 32175803 DOI: 10.1089/lap.2019.0650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To present the outcomes of the laparoscopic and robotic treatment of pediatric simple renal cysts with two novel modifications: the indocyanine green (ICG) fluorescence and the perirenal fat tissue wadding technique. Methods: Between 2012 and 2019, 13 patients with solitary renal cysts were treated through minimally invasive approach. Preoperative work-up included ultrasonography and computed tomography or magnetic resonance. A cyst deroofing was performed in all cases. In the last 3 cases, the ICG fluorescence technique enabled a clear identification and safe puncture of the cyst dome. Five cysts were filled with perirenal fat tissue after deroofing. Results: Thirteen patients (9 boys) were treated through laparoscopic (6 patients), retroperitoneoscopic (3 patients), or robotic approach (4 patients). Median age was 8 years (5-15 years). The median cyst size was 70 mm (42-160 mm). Eight cysts were located in the right kidney. All cysts were progressive and symptomatic. Thirteen cysts (100%) were graded as type II according to the Bosniak classification. No conversion was recorded. The median operative time for laparoscopy was 50 minutes (35-90 minutes) and 85 minutes for robotics (65-120 minutes) including surgical and docking time. No intraoperative complications occurred. The median hospital stay was 2 days (36-96 hours). No residual liquid was detected on follow-up after deroofing and fat tissue wadding technique. Conclusions: Cyst deroofing is an effective and durable treatment for symptomatic simple renal cysts. Robotics enables excellent tissue dissection and ergonomics. The perirenal fat tissue wadding of the cyst seems to reduce the recurrence rate. The ICG fluorescence technique allows for better identification of the cyst and safer surgical procedure.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Andrea Soria-Gondek
- Pediatric Surgery Unit, Hospital Universitari Germans Trias i Pujol., Badalona, Barcelona, Spain
| | | | - Mariapina Cerulo
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Fulvia Del Conte
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Giovanni Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Carmine Pecoraro
- Pediatric Surgery Unit, Santobono Children Hospital, Naples, Italy
| | - Domenico Cicala
- Pediatric Surgery Unit, Santobono Children Hospital, Naples, Italy
| | - Alessandra Farina
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
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Choi JD, Yoo TK, Kang JY, Moon KT, Kim JH, Ahn SH, Lee JH, Cho JM. A Comparative Study of Percutaneous Aspiration with Sclerotherapy and Laparoscopic Marsupialization for Symptomatic Simple Renal Cysts. J Laparoendosc Adv Surg Tech A 2020; 30:514-519. [PMID: 31928507 DOI: 10.1089/lap.2019.0745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Percutaneous aspiration with sclerotherapy (PAS) and laparoscopic marsupialization (LM) are minimally invasive treatment modalities for renal cysts. We aimed to compare the efficacy and cost/effectiveness of LM and PAS for the treatment of simple symptomatic renal cysts. Methods: Data were prospectively collected from three health care institutions in which 80 patients with symptomatic simple renal cysts underwent a single session of PAS with 95% ethanol (PAS group, n = 40) or underwent LM under general anesthesia (LM group, n = 40) between March 2012 and May 2016. We compared the patient profile, duration of procedure, duration of hospital stay, radiological and symptomatic success rates, treatment costs, and incidence of complications between the two groups. Results: At the 6-month follow-up, the radiological success rate in the LM group was significantly greater than that in the PAS group (97.5% versus 60%; P < .001). The symptomatic success rate was comparable in the two groups (95% versus 90%; P = .675). The treatment failure rate did not significantly differ between the two groups (5.0% versus 17.5%, P = .154). The mean total cost in the PAS and LM groups was 1256 USD and 2343 USD, respectively (P = .001). No significant between-group difference was noted regarding the overall complication rate (P = .615). Conclusions: Both LM and PAS are effective and safe procedures for the treatment of symptomatic simple renal cysts. A single session of PAS seems to be a cost-effective method for the management of symptomatic simple renal cysts.
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Affiliation(s)
- Jae Duck Choi
- Department of Urology, Eulji Genaral Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji Genaral Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Jung Yoon Kang
- Department of Urology, Eulji Genaral Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Kyong Tae Moon
- Department of Urology, Eulji Genaral Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Jung Hoon Kim
- Department of Urology, Hanil General Hospital, KEPCO Medical Foundation, Seoul, Republic of Korea
| | - Seung Hyun Ahn
- Department of Urology, Hanil General Hospital, KEPCO Medical Foundation, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Republic of Korea
| | - Jeoung Man Cho
- Department of Urology, Eulji Genaral Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
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丁 光, 程 嗣, 方 冬, 杨 昆, 李 学, 周 辉, 张 骞, 叶 雄, 周 利. [Review of upper urinary modified minimal invasive surgical technology]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:610-614. [PMID: 31420609 PMCID: PMC7433496 DOI: 10.19723/j.issn.1671-167x.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/20/2022]
Abstract
Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it's important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as "4TB principals", which include "tension-free", "water-tight", "thin suture", "no touch of the key area" and "protecting the blood supply". Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.
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Affiliation(s)
- 光璞 丁
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 嗣达 程
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 冬 方
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 昆霖 杨
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 学松 李
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 辉霞 周
- 中国人民解放军总医院第七医学中心八一儿童医院泌尿外科, 北京 100700Department of Pediatric Urology, Bayi Children’s Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, No 5 Nanmencang, Beijing, 100700, China
| | - 骞 张
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 雄俊 叶
- 北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 利群 周
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
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Mehrabi S, Mousavi-Bahar SH, Sabizi-Vand F, Joughehdoust S. Comparison of single session alcohol injection effects on treatment of simple renal cysts. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Liu W, Zhang C, Wang B, Li B, Gao G, Sun G, Sun Y, Lin G. Randomized study of percutaneous ureteroscopic plasma column electrode decortication and laparoscopic decortication in managing simple renal cyst. Transl Androl Urol 2018; 7:260-265. [PMID: 29732285 PMCID: PMC5911539 DOI: 10.21037/tau.2018.03.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic plasma column electrode (PCE) by comparing laparoscopic decortication in the management of simple renal cyst (SRC). Methods Between March 2016 and June 2017, 53 patients with SRCs were randomized to divided into two groups, the PCE group (24 patients), or laparoscope group (29 patients). The operative time, blood loss, days of drainage, catheter, and hospital stay and complications were compared with the two groups. All patients were followed- up to 6 months after treatment. Results No patients had intraoperative complications such as hemopneumothorax, adjacent organ injury, infection or hemorrhage shock. In the PCE group and laparoscope group: the mean operation time was 34.1±8.2 vs. 58.4±16.7 min (P<0.05). The mean blood loss was 2.0±1.16 vs. 9.7±4.09 mL (P<0.05). The mean postoperative indwelling drainage tube time was 2.5±1.5 vs. 2.9±1.09 d (P>0.05). The mean intra-urethral indwelling catheter time was 2.1±0.88 vs. 2.0±1.15 d (P>0.05). The mean postoperative hospital stay was 3.0±1.7 vs. 3.7±1.53 (P>0.05). One patient in electrode group was suffered from rupture of the collecting system during the operation, and was treated by indwelling D-J stent. During follow up, no cysts recurrence was found. Conclusions Percutaneous ureteroscopic PCE decortication is a safe, minimally invasive and effective therapy to treat SRCs, with equal efficacy and advantages in shortening the operation time and reducing the amount of intraoperative bleeding compared with laparoscopic decortication.
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Affiliation(s)
- Weiguang Liu
- Department of Urology, The Affiliated Hospital, Weifang Medical University, Weifang 261031, China
| | - Chengrong Zhang
- Department of Surgery, Weifang Medical Unveristy, Weifang 261053, China
| | - Bohan Wang
- Department of Urology, School of Medicine, University of California, San Francisco, CA, USA
| | - Bao Li
- Department of Urology, The Affiliated Hospital, Weifang Medical University, Weifang 261031, China
| | - Guojun Gao
- Department of Urology, The Affiliated Hospital, Weifang Medical University, Weifang 261031, China
| | - Guobao Sun
- Department of Urology, The Affiliated Hospital, Weifang Medical University, Weifang 261031, China
| | - Yuansheng Sun
- Department of Surgery, Weifang Medical Unveristy, Weifang 261053, China
| | - Guiting Lin
- Department of Urology, School of Medicine, University of California, San Francisco, CA, USA
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Lai S, Xu X, Diao T, Jiao B, Jiang Z, Zhang G. The efficacy of retroperitoneal laparoscopic deroofing of simple renal cyst with perirenal fat tissue wadding technique: A retrospective study. Medicine (Baltimore) 2017; 96:e8259. [PMID: 29019896 PMCID: PMC5662319 DOI: 10.1097/md.0000000000008259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Treatment options for simple renal cyst (SRC) include open surgery, laparoscopy with decortication, or percutaneous aspiration with or without sclerotherapy. Though laparoscopic unroofing achieves better results than percutaneous sclerotherapy, the reported recurrence rate is still up to 19%. Thus, it is necessary to find methods to reduce the recurrence rate.To investigate whether the perirenal pedicled fat tissue wadding technique during retroperitoneal laproscopic deroofing (RLD) of SRC affects the incidence of recurrence.A retrospective analysis was carried out on clinical data of 254 patients with SRC treated by RLD in our hospital from 2008 to 2016. Among these patients,119 had a simple retroperitoneal deroofing (SRD) and 135 received a retroperitoneoscopic deroofing with wadding of the cyst using perirenal fat tissue (RDCW). The recurrence rate and variables, as well as perioperative complications, were compared. To further explore the potential variables influencing cyst recurrence rate, univariate and multivariate regression analyses were applied.A total of 251 patients were included in the analysis. The operation was successfully completed laparoscopically in all cases with no conversion to open surgery. No mortality or significant complication occurred in both groups. After a median follow-up of 38.67 months, we noted 41 recurrences. According to the univariate and multivariate regression analyses, patients managed with the wadding technique had superior recurrence-free survival (RFS), compared with patients in SRD group (log-rank P = .03 and P = .04, respectively). Moreover, patients with single renal cyst had a lower recurrence rate, compared with patients with multiple renal cysts (log-rank P < .01). Regarding the operation time, blood loss, and hospital stay, no statistically significant difference was found between 2 groups (P values .13, .30, and .75, respectively). However, less postoperative drainage and shorter postoperative interval until tube removal (P = .04) were observed in RDCW group.The perirenal pedicled fat tissue wadding technique can decrease the cyst recurrence rate and RCDW represents an effective and safe treatment option in the management of renal cysts.
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Affiliation(s)
- Shicong Lai
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Xin Xu
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Tongxiang Diao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Zhaoqiang Jiang
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
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Bas O, Nalbant I, Can Sener N, Firat H, Yeşil S, Zengin K, Yalcınkaya F, Imamoglu A. Management of renal cysts. JSLS 2016; 19:e2014.00097. [PMID: 25848184 PMCID: PMC4376217 DOI: 10.4293/jsls.2014.00097] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Renal cysts have a high prevalence in the general population, and their estimated incidence increases with age. Renal cyst aspiration (usually with sclerotherapy) or open/laparoscopic decortication is a generally effective and safe method in the treatment of symptomatic simple renal cysts. The success rates of laparoscopic decortication and percutaneous aspiration-sclerotherapy were compared to assist in the decision making for the procedure. Methods: A total of 184 patients with symptomatic simple renal cysts were treated with either laparoscopic decortication in 149 cases or percutaneous aspiration-sclerotherapy in 35 cases. The follow-up period was approximately 35 months, and the symptomatic and radiologic success rates of the 2 techniques were compared retrospectively. Results: Laparoscopic decortication was found to have high success rates, a low recurrence rate, and minimal morbidity. Percutaneous aspiration-sclerotherapy is an outpatient procedure with a minimally higher recurrence rate. Conclusion: When a symptomatic cyst is encountered and treatment of the cyst is indicated, laparoscopic decortication is a more efficient method that offers better results than percutaneous aspiration-sclerotherapy.
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Affiliation(s)
- Okan Bas
- Department of Urology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ministry of Health, Ankara, Turkey
| | - Ismail Nalbant
- Department of Urology, Yenimahalle State Hospital, Ministry of Health, Ankara, Turkey
| | - Nevzat Can Sener
- Department of Urology, Numune Education and Research Hospital, Ministry of Health, Adana, Turkey
| | - Hacer Firat
- Department of Radiology, Diskapi Yildirim Beyazid Education and Research Hospital, Ministry of Health, Ankara, Turkey
| | - Süleyman Yeşil
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Kürşad Zengin
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Fatih Yalcınkaya
- Department of Urology, Diskapi Yildirim Beyazid Education and Research Hospital, Ministry of Health, Ankara, Turkey
| | - Abdurrahim Imamoglu
- Department of Urology, Diskapi Yildirim Beyazid Education and Research Hospital, Ministry of Health, Ankara, Turkey
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Ali TA, Abdelaal MA, Enite A, Badran YA. Ultrasound-guided percutaneous sclerotherapy of simple renal cysts with n-butyl cyanoacrylate and iodized oil mixture as an outpatient procedure. Urol Ann 2016; 8:51-5. [PMID: 26834402 PMCID: PMC4719512 DOI: 10.4103/0974-7796.162216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of this study was to evaluate the efficacy and safety of ultrasound guided percutaneous sclerotherapy of symptomatic simple renal cysts with n-butyl cyanoacrylate (NBCA) and iodized oil mixture as an outpatient single session procedure. Materials and Methods: A total of ninety two patients with 100 symptomatic simple renal cysts (larger than 5 cm) were treated by ultrasound (US)-guided percutaneous aspiration and injection of NBCA and iodized oil mixture. The patients (68 men and 24 women, mean age, 42.4 ± 10.5 years) were treated with as out-patients. The volume of the treated cysts was calculated with periodic noncontrast enhanced CT examinations 3, 6 and 9, months after the procedure. The procedure was considered successful at follow-up CT when there was total ablation or greater than 80% reduction of size with resolution of symptoms, respectively. Failure was defined as less than 80% reduction and/or persistent symptoms. Results: The sclerotherapy was technically successful in all patients. The diameter of the cysts ranged between 5.5 and 13.5 cm (mean, 8.8 ± 1.4 cm), and 1.5 and 3.8 cm (mean, 2.1 ± 0.4 cm) before and after sclerotherapy, respectively (P < 0.001). Average diameter reduction was 83.7% during the follow-up period. The mean follow- up lasted 7.1 months (3–11 months). Flank pain resolved in 86 of 92 symptomatic patients (93.48%). In six patients, the symptoms decreased slightly. The procedure was successful in 98 of 100 cysts (98%), demonstrated by follow-up CT. The only two failed cyst was larger than 10 cm in diameter and don’t required any further treatment. We did not observe any procedure related complications. Conclusion: Ultrasound guided percutaneous sclerotherapy with NBCA and iodized oil mixture for management of symptomatic simple renal cysts was found to be a real time, effective, safe, well tolerated, alternative and simple technique that can be carried out by urologists as an outpatient procedure.
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Affiliation(s)
- Tamer A Ali
- Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt
| | | | - Ashraf Enite
- Department of Radiology, Al-Azhar Faculty of Medicine, Cairo, Egypt
| | - Yasser A Badran
- Department of Urology, Al-Azhar Faculty of Medicine, Cairo, Egypt
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Efesoy O, Tek M, Bozlu M, Doruk HE. Comparison of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts. Turk J Urol 2015; 41:14-9. [PMID: 26328192 DOI: 10.5152/tud.2015.77675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/05/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to compare the efficacy and cost-effectiveness of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts. MATERIAL AND METHODS Between March 2010 and December 2012, patients with simple renal cysts presenting with pressure and pain symptoms were divided into two groups. In Group 1 following local anesthetic administration, single session percutaneous aspiration with 95% ethanol sclerotherapy (n=38) and in Group 2 transperitoneal laparoscopic de-roofing under general anesthesia (n=42) were performed. The data were evaluated retrospectively and demographic characteristics, duration of operation and hospitalization, complication rates, cost effectiveness, radiological and symptomatic success rates at six month- follow-up were compared between the two groups. RESULTS The mean age and gender of the patients, cyst diamater, side and localization of the cyst and indications for intervention were similar in two groups. The median course of treatment and hospitalization were signifcantly decreased in Group 1 (respectively 33 min versus 59 min and 6 hours versus 24 hours, p<0.001). As complications in Group 1 fever in two patients (5.3%) and in Group 2 bleeding requiring transfusion in one patient (2.4%) were observed (p=0.495). Total cost was calculated as $ 131.7 in Group 1 and $ 729.8 in Group 2. After the sixth month follow-up control radiological success rates were found to be signifcantly higher in Group 2, while symptomatic success rate is similar in both groups (63.2% versus 95.2%, p<0.001; 94.7% versus 97.6%, p=0.498, respectively). CONCLUSION Single-session percutaneous aspiration with alcohol sclerotherapy and laparoscopic de-roofing are safe and effective methods in the treatment of symptomatic simple renal cysts. While radiological recurrence rate was higher in single session percutaneous aspiration with alcohol sclerotherapy, however similar symptomatic recurrence rates were seen with laparoscopy. Therefore single session percutaneous aspiration combined with alcohol sclerotherapy seems to be an important option in the treatment of simple renal cysts when considering the duration of the operation, hospitalization and total costs of the process.
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Affiliation(s)
- Ozan Efesoy
- Clinic of Urology, Toros State Hospital, Mersin, Turkey
| | - Mesut Tek
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Murat Bozlu
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hasan Erdal Doruk
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Turkey
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Koutlidis N, Joyeux L, Méjean N, Sapin E. Management of simple renal cyst in children: French multicenter experience of 36 cases and review of the literature. J Pediatr Urol 2015; 11:113-7. [PMID: 25934353 DOI: 10.1016/j.jpurol.2015.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The widespread use of renal ultrasonography has resulted in simple renal cysts (SRC) being discovered with increasing frequency in routine pediatric urological practice. Management of SRC, however, remains controversial. Most SRC are asymptomatic, are diagnosed incidentally, and have no clinical consequence. Our goal was to focus on management strategies for SRC in children with the support of our experience and a review of the literature. MATERIALS AND METHODS A literature review was made of SRC in children since 1950, analyzing epidemiologic data, diagnosis, and management. In addition, a retrospective multicenter study was conducted from 1998 to 2009. Patients included presented with a unique SRC. Data recorded were patient characteristics (age, gender), symptoms, imaging features of the cyst (size, side, pole, and location), type of management, and long-term outcomes. To focus on management, two groups of patients were defined: primary surgical management and primary conservative management consisting of clinical and US follow-up. Our results were compared with the literature. RESULTS Thirty-six cases were included. Fifteen patients were symptomatic. Comparing the two groups, long-term outcomes were similar. The only significant factors were preoperative (age of the patient, diameter and location of the cyst): the bigger the cyst, the more likely it was to be exorenal, and the greater the likelihood that surgery would be performed (p = 0.006). Symptoms were not a significant indicator for surgery. CONCLUSION According to the literature and our experience, and considering the benign natural history of SRC and the similar outcomes whatever the treatment, primary conservative management is recommended for all cases. Surgery should be restricted to symptomatic large compressive cysts, increase in cyst size on follow-up, and uncertain diagnosis. Percutaneous cyst aspiration with sclerotherapy has not yet been used enough to ascertain its safety, and requires prospective evaluation.
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Affiliation(s)
- Nicolas Koutlidis
- Department of Paediatric Surgery, Children's Hospital of Dijon, University Medical Center, Dijon, France.
| | - Luc Joyeux
- Department of Paediatric Surgery, Children's Hospital of Dijon, University Medical Center, Dijon, France.
| | - Nathalie Méjean
- Department of Radiology, Children's Hospital of Dijon, University Medical Center, 21079, Dijon, France.
| | - Emmanuel Sapin
- Department of Paediatric Surgery, Children's Hospital of Dijon, University Medical Center, Dijon, France.
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Symptomatic abdominal simple cysts: is percutaneous sclerotherapy with hypertonic saline and bleomycin a treatment option? Gastroenterol Res Pract 2015; 2015:489363. [PMID: 25878660 PMCID: PMC4386601 DOI: 10.1155/2015/489363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/27/2015] [Accepted: 02/27/2015] [Indexed: 01/26/2023] Open
Abstract
Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts.
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Yonguc T, Sen V, Aydogdu O, Bozkurt IH, Yarimoglu S, Polat S. The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts. Int Urol Nephrol 2015; 47:603-7. [DOI: 10.1007/s11255-015-0953-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
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[Laparoscopic fenestration for a symptomatic lymphocele in renal graft after living-donor kidney transplantation]. Nihon Hinyokika Gakkai Zasshi 2014; 105:139-43. [PMID: 25158557 DOI: 10.5980/jpnjurol.105.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 36-year-old female received protocol biopsy at 1 month after living donor kidney transplantation. At 3 months post-transplantation, presence of a growing cystic mass in the kidney graft which had not been detected preoperatively, was demonstrated by ultrasound and computed tomography. The patient had an abdominal pain around the graft. Percutaneous drainage and sclerotherapy with minocyclin were performed twice, but the cystic mass, nevertheless, became enlarged and the abdominal pain recurred again. Laparoscopic fenestration was then performed. Immunohistochemistry of the cystic mass wall showed that it was CD34 (-), EMA (-), Megalin (-), but D2-40 (+). These results suggested that the cystic mass was derived from lymphatic vessels, which developed into lymphocele in the graft. We concluded that lymphatic vessels could have been injured and obstructed by the protocol biopsy. This is the first report of successful laparoscopic fenestration for lymphocele in the kidney graft.
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Treatment of renal parapelvic cysts with a flexible ureteroscope. Int Urol Nephrol 2014; 46:1903-8. [DOI: 10.1007/s11255-014-0741-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
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Monville H, Wagner L, Dibo D, Soustelle L, Muyshondt C, Droupy S, Costa P. Sclérothérapie percutanée à l’éthanol des kystes rénaux symptomatiques : résultats à 4 ans. Prog Urol 2014; 24:353-8. [DOI: 10.1016/j.purol.2013.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 10/24/2013] [Accepted: 11/03/2013] [Indexed: 10/25/2022]
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Yu JH, Du Y, Li Y, Yang HF, Xu XX, Zheng HJ. CT-guided sclerotherapy for simple renal cysts: value of ethanol concentration monitoring. Korean J Radiol 2014; 15:80-6. [PMID: 24497796 PMCID: PMC3909866 DOI: 10.3348/kjr.2014.15.1.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/03/2013] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. Materials and Methods Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. Results After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. Conclusion Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.
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Affiliation(s)
- Jin Hong Yu
- Department of Ultrasound, the Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province 637000, China
| | - Yong Du
- Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province 637000, China
| | - Yang Li
- Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province 637000, China
| | - Han Feng Yang
- Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province 637000, China
| | - Xiao Xue Xu
- Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province 637000, China
| | - Hou Jun Zheng
- Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province 637000, China
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Khan MQ, Ponor IL, Ross AE, Khaliq W. Management of a simple renal cyst in a complex patient. BMJ Case Rep 2013; 2013:bcr-2013-009270. [PMID: 23744857 DOI: 10.1136/bcr-2013-009270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal cysts are generally classified as simple or complex and are further characterised under the Bosniak classification system. Most simple cysts are benign, asymptomatic and discovered incidentally. However, over time, these simple cysts can enlarge, become symptomatic and develop complications, requiring intervention. We present a case of a 70-year-old man with multiple comorbidities who presented with left lower quadrant abdominal pain and haematuria. An abdominal CT scan revealed a large, 26 cm exophytic cyst with high attenuation areas, septations and haemorrhage. Given the patient's tenuous condition and poor functional status, an interventional radiology-guided renal cyst aspiration was performed, resulting in successful reduction of size and symptom resolution. A follow-up ultrasound at 6 months showed no evidence of recurrence. Primary care providers should be aware of the prevalence of renal cysts and their complications, especially haemorrhage, particularly in high risk and elderly patients on anticoagulation or antiplatelet therapy.
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Laparoscopic aspiration for central renal angiomyolipoma: a novel technique based on single-center initial experience. Urology 2013; 81:313-8. [PMID: 23374791 DOI: 10.1016/j.urology.2012.09.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 08/29/2012] [Accepted: 09/10/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To report on the novel technique of laparoscopic aspiration for central renal angiomyolipoma (RAML) in a series of patients treated in our institution and summarize our single-center initial experience. METHODS We retrospectively reviewed the clinical data of 10 patients (4 men and 6 women) with pathologically confirmed central RAML who underwent laparoscopic aspiration between August 2010 and May 2012. Indications for surgical intervention included 8 (80%) tumors of >4 cm and 2 (20%) symptomatic RAMLs. Patient demographics, intraoperative variables, and postoperative outcomes were reported and analyzed. Follow-up was performed by serum creatinine and imaging techniques. RESULTS All patients were diagnosed with sporadic central RAML. None was affected by tuberous sclerosis. All operations were performed successfully by laparoscopic aspiration without conversion to partial nephrectomy, enucleation, or even open surgery. One complication of perirenal fluid collection occurred but finally recovered only with conservative treatment. No other complication or transfusion was observed. The mean tumor size was 5.1 cm (range 3.2-7.7 cm). The mean operative time was 92.1 minutes (range 67-140). The mean warm ischemia time was 27.5 minutes (range 20-30). The mean estimated blood loss was 53.5 mL (range 10-150). The mean retroperitoneal drainage was 2.3 days (range 1-3). The mean postoperative hospital stay was 4.3 days (range 3-8). The level of serum creatinine were all within normal limits with mean preoperative and postoperative 0.85 mg/dL (range 0.55-1.07) and 1.11 mg/dL (range 0.71-1.26), respectively. No recurrence or new lesions occurred in these patients at a mean follow-up of 7.7 months. CONCLUSION Our initial experience suggests that the novel technique of laparoscopic aspiration is a feasible, safe, and effective minimally invasive procedure for the treatment of RAML, especially the central RAML. It can be a nephron-sparing alternative and recommended in well-selected patients that might prove to be safer, with equal efficacy, and should be further explored.
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Agarwal M, Agrawal MS, Mittal R, Sachan V. A Randomized Study of Aspiration and Sclerotherapy Versus Laparoscopic Deroofing in Management of Symptomatic Simple Renal Cysts. J Endourol 2012; 26:561-5. [DOI: 10.1089/end.2011.0559] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mayank Agarwal
- Department of Surgery, SN Medical College, Agra, Uttar Pradesh, India
| | - Madhu S. Agrawal
- Department of Surgery, SN Medical College, Agra, Uttar Pradesh, India
| | - Ruchi Mittal
- Department of Surgery, SN Medical College, Agra, Uttar Pradesh, India
| | - Vivek Sachan
- Department of Surgery, SN Medical College, Agra, Uttar Pradesh, India
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Skolarikos A, Laguna MP, de la Rosette JJ. Conservative and radiological management of simple renal cysts: a comprehensive review. BJU Int 2012; 110:170-8. [DOI: 10.1111/j.1464-410x.2011.10847.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Retroperitoneoscopic Decortication of Symptomatic Peripelvic Renal Cysts: Chinese Experience. Urology 2011; 78:803-7. [DOI: 10.1016/j.urology.2011.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 06/10/2011] [Accepted: 06/10/2011] [Indexed: 11/19/2022]
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CT-Guided Sclerotherapy With Ethanol Concentration Monitoring for Treatment of Renal Cysts. AJR Am J Roentgenol 2011; 196:W78-82. [PMID: 21178037 DOI: 10.2214/ajr.10.4671] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Li EC, Hou JQ, Yang LB, Yuan HX, Hang LH, Alagirisamy KK, Li DP, Wang XP. Pure Natural Orifice Translumenal Endoscopic Surgery Management of Simple Renal Cysts: 2-Year Follow-Up Results. J Endourol 2011; 25:75-80. [PMID: 21247290 DOI: 10.1089/end.2009.0676] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- En-Chun Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jian-Quan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lin-Bin Yang
- Department of Urology, Jiaxing First Hospital, Jiaxing, Zhejiang, China
| | - He-Xing Yuan
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Li-Hua Hang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | | | - Da-Peng Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Ping Wang
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Brodin-Sartorius A, Timsit MO, Correas JM, Joly D, Bollee G. Not so simple renal cysts. Clin Kidney J 2010; 3:498-500. [PMID: 25984067 PMCID: PMC4421711 DOI: 10.1093/ndtplus/sfq118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/09/2010] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Jean-Michel Correas
- Université Paris Descartes
- Department of Radiology, Hôpital Necker, Paris, France
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Maeda T, Uchida Y, Oyamada K, Nakajima F. Thrombosis in inferior vena cava due to enlarged renal cysts in autosomal dominant polycystic kidney disease. Intern Med 2010; 49:1891-4. [PMID: 20823652 DOI: 10.2169/internalmedicine.49.3748] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a rare case of thrombosis in the inferior vena cava (IVC) due to enlarged cysts in autosomal dominant polycystic kidney disease. A 71-year-old woman visited our hospital with a complaint of rapid left lower extremity swelling. Computed tomography (CT) revealed massive thrombosis from the IVC to the bilateral common iliac vein. The extrinsic mechanical stress of renal cysts to the IVC seemed to have induced thrombosis in the vein that resulted in the cause of severe edema in the left lower extremity. Her renal cysts were percutaneously punctured for the relief of compression and she received injection of 99.5% ethanol for prevention against reaccumulation of cyst fluid after IVC filter had been positioned. The edema of her left lower extremity improved temporarily, however, follow-up CT two months after cyst puncture showed reaccumulation of the fluid. Therefore, excision of the responsible cyst wall by open surgery was carried out.
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Ryu DS, Oh TH. Laparoscopic Decortication of Large Renal Cysts: A Comparison Between the Transperitoneal and Retroperitoneal Approaches. J Laparoendosc Adv Surg Tech A 2009; 19:629-32. [DOI: 10.1089/lap.2009.0008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dong-Soo Ryu
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Tae-Hee Oh
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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Place de la ponction-sclérothérapie à la polyvidone-iodine dans le traitement des kystes rénaux simples symptomatiques. ACTA ACUST UNITED AC 2009; 90:1075-8. [DOI: 10.1016/s0221-0363(09)73247-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Omerović S, Zerem E. Alcohol sclerotherapy in the treatment of symptomatic simple renal cysts. Bosn J Basic Med Sci 2009; 8:337-40. [PMID: 19125704 DOI: 10.17305/bjbms.2008.2893] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Safet Omerović
- Department of Urology, General Hospital Mostar, Mostar, Bosnia and Herzegovina
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A New Technique for Simple Renal Cyst: Cystoretroperitoneal Shunt. Adv Urol 2009:906013. [PMID: 19606254 PMCID: PMC2709719 DOI: 10.1155/2009/906013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 05/22/2009] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the results of patient symptoms and radiologic outcomes of cystoretroperitoneal shunt (CRS) technique in the treatment of symptomatic simple renal cysts. Patients and Methods. In a prospective study, 37 patients with a simple renal cyst were treated with ultrasound-guided percutaneous CRS-catheter. Radiological success was indicated as no recurrence of the cyst or a reduction in cyst volume by at least half. Results. CRS technique was performed successfully in 36 patients with a simple renal cyst. The mean size of all cysts decreased from 8.8 cm (range 7 to 14) to 1.7 cm (range 0 to 9; P < .001). Symptomatic success (pain relief) was achieved in 29/36 (80.5%) of patients, and radiographic success was achieved in 23/36 (63.8%) of patients, with a median follow-up of 16 months (range 6 to 24). Conclusion. Ultrasound-guided percutaneous CRS technique for simple renal cysts is fast, safe, effective, and inexpensive.
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Symptomatic simple renal cyst: comparison of continuous negative-pressure catheter drainage and single-session alcohol sclerotherapy. AJR Am J Roentgenol 2008; 190:1193-7. [PMID: 18430831 DOI: 10.2214/ajr.07.2867] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Abbaszadeh S, Taheri S, Nourbala MH. Laparoscopic decortication of symptomatic renal cysts: Experience from a referral center in Iran. Int J Urol 2008; 15:486-9. [PMID: 18422580 DOI: 10.1111/j.1442-2042.2008.02031.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shahin Abbaszadeh
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Egilmez H, Gok V, Oztoprak I, Atalar M, Cetin A, Arslan M, Gultekin Y, Solak O. Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst. Korean J Radiol 2008; 8:512-9. [PMID: 18071282 PMCID: PMC2627454 DOI: 10.3348/kjr.2007.8.6.512] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts. MATERIALS AND METHODS A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography. RESULTS The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group. CONCLUSION Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.
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Affiliation(s)
- Hulusi Egilmez
- Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
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Demir E, Alan C, Kilciler M, Bedir S. Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst. J Endourol 2007; 21:903-5. [PMID: 17867950 DOI: 10.1089/end.2006.0462] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst. PATIENTS AND METHODS Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months. RESULTS There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019). CONCLUSIONS Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.
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Affiliation(s)
- Erkan Demir
- Department of Urology, Cukurova University Medical Faculty, Adana, Turkey.
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Abstract
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.
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Affiliation(s)
- Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, 134 Sinchon-Dong, Seodaemun-Gu, Seoul, Korea.
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Seo JH, Kim TH, Sung GT. Efficacy of Laparoscopic Renal Cyst Marsupialization for Patients Suffering with Simple Renal Cyst. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.5.477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ju Hyung Seo
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Gyung Tak Sung
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
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Atug F, Burgess SV, Ruiz-Deya G, Mendes-Torres F, Castle EP, Thomas R. Long-term durability of laparoscopic decortication of symptomatic renal cysts. Urology 2006; 68:272-5. [PMID: 16904433 DOI: 10.1016/j.urology.2006.03.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 01/23/2006] [Accepted: 03/07/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the long-term results of patient symptoms and radiologic outcomes of laparoscopic renal cyst decortication in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population. Symptomatic renal cysts have traditionally been treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence. METHODS From April 1994 through July 2005, 45 patients underwent laparoscopic decortication of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. Of the 45 patients, 24 (53.3%) had undergone previous cyst aspiration with injection of sclerosant material for intended ablation. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan. RESULTS Of the 45 procedures, 44 were completed laparoscopically. One patient (1.8%) underwent open conversion because of excessive bleeding. The mean operative time was 89 minutes (range 48 to 170). Symptomatic success was achieved in 91.1% of patients, with a median follow-up of 52 months (range 3 to 132), and radiographic success was achieved in 95.5% of patients, with a median follow-up of 39 months (range 3 to 96). CONCLUSIONS Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities.
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Affiliation(s)
- Fatih Atug
- Department of Urology, Center for Minimally Invasive Urologic Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
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Shiraishi K, Eguchi S, Mohri J, Kamiryo Y. Laparoscopic decortication of symptomatic simple renal cysts: 10-year experience from one institution. BJU Int 2006; 98:405-8. [PMID: 16879687 DOI: 10.1111/j.1464-410x.2006.06249.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the long-term results by symptomatic and radiological outcome of laparoscopic decortication of renal cyst, first reported in 1992. PATIENTS AND METHODS We retrospectively reviewed the records of 36 patients who had a total of 36 laparoscopic decortications at our institution between December 1993 and March 2004. Of these cysts, 30 were peripheral and six were peripelvic cysts; the patients were asked if they had pain or not. Changes of cyst size after decortication were determined by computed tomography and the serial changes of each cyst were evaluated as the percentage of the diameter before surgery. The relationships between radiological and symptomatic outcome or cyst location were examined. RESULTS Peri-operative morbidity was satisfactory; with a mean (range) follow-up of 67.2 (13-128) months the symptomatic and radiological success rates were 92% (33 of 36) and 81% (25 of 36), respectively. Peripelvic cysts were significantly correlated with radiological failure. Symptomatic improvement was evident by 3 months, while radiological improvement continued for up to 3-4 years after surgery. Seven asymptomatic patients with radiological failure selected a conservative follow-up. CONCLUSIONS Laparoscopic decortication is safe and provides long-term satisfactory symptomatic results. The radiological improvement was slower than the symptomatic improvement and several cysts remained large, indicating some reduction in volume that was enough to improve the symptoms. This procedure is still challenging for peripelvic cysts in terms of radiological results, yet feasible for the clinical outcome.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
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Tefekli A, Altunrende F, Baykal M, Sarilar O, Kabay S, Muslumanoglu AY. Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors. Int J Urol 2006; 13:331-6. [PMID: 16734845 DOI: 10.1111/j.1442-2042.2006.01299.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
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Abstract
Cystic diseases of the kidney constitute a heterogeneous family. Most renal cysts are benign and asymptomatic, and don't have any impact on renal function. These "simple" cysts are usually managed conservatively. However, some renal cysts may be symptomatic or may have atypical radiological presentation, leading to suspicion of malignant tumour; puncture or surgical investigation may be indicated in such cases. The other cystic renal diseases include specific entities, either genetic or acquired during development. Some malformative syndromes are often associated, and renal function may be impaired. In such cases, nephrectomy is required.
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Affiliation(s)
- N B Delongchamps
- Service d'urologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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