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Wang Z, Zeng X, Chen C, Wang T, Chen R, Liu J. Methylene Blue Injection via Percutaneous Renal Cyst Puncture Used in Flexible Ureteroscope for Treatment of Parapelvic Cysts: A Modified Method for Easily Locating Cystic Wall. Urology 2018; 125:243-247. [PMID: 30452965 DOI: 10.1016/j.urology.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe a modified technique for easily locating cystic wall during flexible ureteroscopic surgery for treatment of parapelvic renal cysts. METHODS Nineteen patients with symptomatic/asymptomatic parapelvic renal cyst were treated with modified or conventional flexible ureteroscopic surgery between February 2015 and March 2017, and the differences of the 2 techniques were compared. The detailed surgical procedures and results, postoperative complications, and patients' follow-ups were evaluated. RESULTS All the patients received endoscopic management by flexible ureteroscope successfully, without requiring another complicated surgery. The cysts were seen clearly in 9 patients with modified method. Two of ten patients who underwent conventional ureteroscopic surgery changed to the modified surgery intra-operatively since it was difficult to identify the cyst. The total time of search and incision of cysts was 24.2 ± 6.2 minutes and 17.7 ± 2.5 minutes for conventional and modified technique respectively (P = .01), of which 11.4 ± 4.8 minutes and 5.1 ± 1.1 minutes to search the cysts, respectively (P = .002), and the mean time of the procedure of puncture was 8 ± 2.3 minutes. Duration of pure incising the cystic wall was 12.8 ± 3.3 minutes and 12.6 ± 2.5 minutes for patients who underwent conventional and modified technique, respectively (P = .859). All patients acquired relief from the presentation of flank discomfort after surgery. All of the patients were followed-up over 12 months and no serious complications and recurrence was observed. CONCLUSION The modified technique can decrease time of searching the renal cyst and decrease the total time in flexible ureteroscopic treatment of parapelvic cysts. The limitations of our study were also observed and further studies are needed.
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Affiliation(s)
- Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chong Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruibao Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Desai D, Modi S, Pavicic M, Thompson M, Pisko J. Percutaneous Renal Cyst Ablation and Review of the Current Literature. J Endourol Case Rep 2016; 2:11-3. [PMID: 27579403 PMCID: PMC4996571 DOI: 10.1089/cren.2015.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Renal cysts are common and most often are discovered incidentally, but may require intervention if associated with pain, hypertension, or hematuria. Minimally invasive treatment options are preferred with numerous modalities available, including renal cyst ablation. This case report of a 61-year-old female describes the effective percutaneous drainage and endoscopic ablation of a simple parapelvic renal cyst for management of symptomatic renal calculus. Current literature regarding this surgical intervention and alternative methods is discussed.
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Affiliation(s)
- Devang Desai
- Urology Department, Gold Coast Hospital , Gold Coast, Australia
| | - Sunny Modi
- Urology Department, Greenslopes Private Hospital , Brisbane, Australia
| | - Matthew Pavicic
- Urology Department, Greenslopes Private Hospital , Brisbane, Australia
| | | | - John Pisko
- Urology Department, Gold Coast Hospital , Gold Coast, Australia
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Gadelmoula M, KurKar A, Shalaby MM. The laparoscopic management of symptomatic renal cysts: A single-centre experience. Arab J Urol 2015; 12:173-7. [PMID: 26019944 PMCID: PMC4434607 DOI: 10.1016/j.aju.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/19/2013] [Accepted: 12/29/2013] [Indexed: 11/16/2022] Open
Abstract
Objectives To present our experience of treating symptomatic renal cysts by different techniques of laparoscopic decortication, as there are many treatment options for such cysts, each of them with advantages and drawbacks. Patients and methods Between January 2002 and December 2012, 51 patients underwent laparoscopic renal-cyst decortication; 15 of them had recurrent cysts after percutaneous aspiration. A retroperitoneal approach was adopted in 44 cases, transperitoneal in four and laparo-endoscopic single-site surgery (LESS) cyst decortication in three (two of them had bilateral renal cyst decortications in the same session). All patients were diagnosed by ultrasonography and computed tomography to determine the Bosniak classification of the cyst. Pain and cyst recurrence were assessed during the follow-up. Results All procedures were completed successfully, with no major intraoperative complications. The mean (range) operative duration was 56 (35–125) min, affected by the site and number of cysts unroofed. All patients were symptom-free except one, who had a recurrent large cyst, anteriorly located, and who underwent open cyst decortication. Conclusions Laparoscopic decortication of symptomatic renal cysts should be the standard of care, especially after failed percutaneous aspiration or decortication. LESS cyst decortication is a promising technique, especially with bilateral pathology. It is feasible with conventional laparoscopic instruments and gives a better cosmetic outcome.
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Affiliation(s)
| | - Adel KurKar
- Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt
| | - Mahmoud M Shalaby
- Department of Urology, Assiut University Hospitals, Assiut 71515, Egypt
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Chen H, Qi L, Wang L. Reply by the authors. Urology 2015; 85:484-5. [PMID: 25623722 DOI: 10.1016/j.urology.2014.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 10/16/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Chen H, Qi L, Zu X, Liu L, Cao Z, Zeng F, Niu J, Cui Y, Wang L. Percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in selected patients: killing two birds with one stone? Urology 2014; 84:1267-71. [PMID: 25239252 DOI: 10.1016/j.urology.2014.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/26/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the safety, feasibility, and efficacy of percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in the management of a renal cyst with ipsilateral calculi in selected patients. MATERIALS AND METHODS Between July 2010 and August 2013, 16 patients (11 men and 5 women; mean age, 51 years) with a solitary posterior or parapelvic renal cyst and ipsilateral calculi underwent percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in our center. Mean cyst size was 6.3 cm (range, 4.2-11.8 cm). Mean stone surface area was 5.8 cm(2) (range, 1.8-12.1 cm(2)). By preoperative computed tomography planning and interoperative ultrasound guidance, the optimal puncture route was selected carefully to marsupialize the cyst and approach the target calyx. The cyst was marsupialized into the collecting system at the dilation process. Subsequently, percutaneous nephrolithotomy was performed in a standard fashion. RESULTS The mean operative time was 68 minutes (range, 47-93 minutes), and the mean hospital stay was 4 days (range, 3-7 days). A nephrostomy tube and a double-J stent were placed for a prolonged period to ensure the channel remained opened. Nearly complete cyst regression and calculi clearance confirmed by postoperative imaging was achieved in all patients. No intraoperative or postoperative complications in Clavien grading score ≥ 2 were noted during a mean follow-up of 21 months (range, 8-25 months). CONCLUSION In selected patients with a posterior or parapelvic renal cyst and ipsilateral calculi, the percutaneous technique is a safe and effective option through intermediate follow-up.
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Affiliation(s)
- Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenzhen Cao
- Department of Gynecologic Oncology, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiping Niu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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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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Abstract
Renal cysts are a common imaging finding. Although most cysts never have symptoms, some cause pain, collecting system compression, hematuria, hypertension, and secondary infection. The mere presence of a cyst is not an indication for intervention, but treatment may be indicated in symptomatic patients or those with secondary obstruction. Urinomas generally are a contained collection of urine outside of the normal pathways where urine travels. As such, urinomas can arise anywhere from the upper abdomen down into the low pelvis and have a variety of etiologies. Ureteral obstruction with forniceal rupture and trauma (blunt, penetrating, or iatrogenic) are the most common causes of urinomas. When urinomas arise spontaneously, the likely cause varies with the patient's age. Blunt or penetrating trauma can cause perinephric urinomas by two mechanisms-direct disruption of the pelvis or collecting system or by degeneration of nonviable tissue. These urinomas are often perinephric, but can also occur in a subcapsular location. This review will discuss diagnosis, classification, and treatment of renal cysts and urinomas.
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Affiliation(s)
- Jessica Lee
- Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Michael Darcy
- Mallinckrodt Institute of Radiology, St. Louis, Missouri
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Tuncel A, Aydin O, Balci M, Aslan Y, Atan A. Laparoscopic decortication of symptomatic simple renal cyst using conventional monopolar device. Kaohsiung J Med Sci 2011; 27:64-7. [PMID: 21354520 DOI: 10.1016/j.kjms.2010.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022] Open
Abstract
In our study, we assessed the efficacy, safety, and feasibility of laparoscopic decortication of symptomatic simple renal cysts using conventional monopolar device. Long-term symptomatic and radiological results of 15 patients who underwent laparoscopic renal symptomatic simple cyst decortication, which was performed by conventional monopolar device, were retrospectively reviewed. The mean age of the patients was 49.7 years. There were nine male and six female patients. Their presenting symptoms were lumber pain in 93% (n=14), and hypertension in 7% (n=1). The mean operating time was 64.6 minutes. The mean hospital stay was 2.2 days. After a mean follow up of 12.08 months, the radiological and symptomatic successes were 100% and 86.6%, respectively. Laparoscopic renal cyst decortication using conventional monopolar device represents an effective and safe treatment option in the management of renal cyst without any need for more expensive energy sources.
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Affiliation(s)
- Altug Tuncel
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey.
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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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Busato WF, Bettega LB. Percutaneous Endocystolysis, a Safe and Minimally Invasive Treatment for Renal Cysts: A 13-Year Experience. J Endourol 2010; 24:1405-10. [DOI: 10.1089/end.2009.0467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wilson F.S. Busato
- Departments of Urology and Experimental Surgery, UNIVALI (University of Itajai Valley), and INCAU (Catarinense's Urological Institute), Itajai, Santa Catarina, Brazil
| | - Luciano B. Bettega
- Departments of Urology and Experimental Surgery, UNIVALI (University of Itajai Valley), and INCAU (Catarinense's Urological Institute), Itajai, Santa Catarina, Brazil
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11
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CHO DS, AHN HS, KIM SI, KIM YS, KIM SJ, JEON GS, WON JH. Sclerotherapy of renal cysts using acetic acid: a comparison with ethanol sclerotherapy. Br J Radiol 2008; 81:946-9. [DOI: 10.1259/bjr/41664864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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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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Shah JB, Whitman C, Lee M, Gupta M. Water under the Bridge: 5-Year Outcomes after Percutaneous Ablation of Obstructing Parapelvic Renal Cysts. J Endourol 2007; 21:1167-70. [DOI: 10.1089/end.2007.9914] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jay B. Shah
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Catherine Whitman
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Michael Lee
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mantu Gupta
- Department of Urology, Columbia University Medical Center, New York, New York
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