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Marret JB, Blanc T, Balaton A, La Vignera S, Zanghì G, Lottmann HB, Bagnara V. Symptomatic Parapelvic Cysts in Children: Anatomical and Histological Features, Diagnostic Pitfalls and Urological Management. J Clin Med 2022; 11:jcm11072035. [PMID: 35407642 PMCID: PMC9000015 DOI: 10.3390/jcm11072035] [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: 03/04/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Symptomatic parapelvic cysts (PPC) are rare entities. Our objective is to highlight specific features of PPC to avoid a misdiagnosis of UPJ obstruction. Methods: We retrospectively reviewed the records of children managed between 2012–2017. Results: All four patients (18 months–8 years) presented with acute renal colic with a large intra-sinusal liquid mass (42–85 mm) on ultrasound, evoking a diagnosis of UPJ obstruction. On preoperative renal scintigraphy (n = 3) there was no dilatation of the renal pelvis and ipsilateral differential function was impaired in 2. Diagnosis of PPC was suspected preoperatively in three children (CT scan (n = 1); MRI (n = 2)) and made peri-operatively (n = 1). Preoperative retrograde pyelography (n = 3) and a further intraoperative retrograde pyelography with methylene blue (n = 1) did not identify communication with the cyst. No renal pelvis was identified in two patients. De-roofing of the cyst was curative in all cases at 5 years mean follow-up (no leakage, cyst recurrence or loss of function) and all 4 patients became asymptomatic after surgery. Histology demonstrated a single flat epithelial cell layer. Renal function normalized in one patient but remained impaired in the other. Conclusion: In case of symptoms of UPJ obstruction with a medial renal liquid mass on ultrasound, PPC should be considered when no dilatated pelvis on renal scan is identified. In such cases, a complementary imaging work-up is mandatory prior to surgery.
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Affiliation(s)
- Jean-Baptiste Marret
- Department of Paediatric Surgery and Urology, Hôpital Necker Enfants Malades, APHP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France; (J.-B.M.); (T.B.); (H.B.L.)
| | - Thomas Blanc
- Department of Paediatric Surgery and Urology, Hôpital Necker Enfants Malades, APHP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France; (J.-B.M.); (T.B.); (H.B.L.)
- Mechanisms and Therapeutic Strategies of Chronic Kidney Disease, INSERM U1151-CNRS UMR 8253, Institut Necker Enfants Malades, Département “Croissance et Signalisation”, Hôpital Necker Enfants Malades, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France
| | - Andre Balaton
- Department of Pathology, Praxea Diagnostics, 1 Rue Galvani, 91300 Massy, France;
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Guido Zanghì
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Henri Bernard Lottmann
- Department of Paediatric Surgery and Urology, Hôpital Necker Enfants Malades, APHP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France; (J.-B.M.); (T.B.); (H.B.L.)
| | - Vincenzo Bagnara
- Department of Paediatric Surgery, Policlinico “G.B. Morgagni”, Via Del Bosco 105, 95125 Catania, Italy;
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Yan KW, Tian XF, Meng N, Liu WZ, Lu ZM, Guo MT, Xiao B. Flexible ureteroscopy with ultrasound guidance for the treatment of parapelvic renal cysts: A complementary approach for locating the cystic wall. BMC Urol 2022; 22:7. [PMID: 35073883 PMCID: PMC8785450 DOI: 10.1186/s12894-022-00960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/18/2022] [Indexed: 12/26/2022] Open
Abstract
Background Flexible ureteroscopic incision and drainage is a relatively new surgical method for treating parapelvic cysts. Considering that the intraoperative localization of the cyst may fail with a flexible ureteroscope, we use an innovative ultrasound-guided method to locate the cystic wall during flexible ureteroscopic surgery. Methods We retrospectively reviewed 17 consecutive cases of parapelvic renal cysts treated by ultrasound-guided flexible ureteroscopy between March 2017 and May 2020. The differences between the simple flexible ureteroscopic technique and ultrasound-guided flexible ureteroscopic technique were compared. The surgical procedures, postoperative complications, results and patient follow-ups were evaluated. Results The cyst wall was seen clearly in 10 patients with ureteroscopic vision. Another 7 patients underwent ultrasound-guided flexible ureteroscopic surgery since it was difficult to identify the cyst wall. The mean operative time was 25.9 ± 8.7 min and 37.1 ± 10.1 min for the conventional and modified techniques, respectively (P = 0.004); the mean time to search for cysts was 17.6 ± 5.8 min and 26.5 ± 8.4 min, respectively (P = 0.002); and the mean incision time was 7.1 ± 4.9 min and 12.1 ± 5.6 min, respectively (P = 0.000). All of the patients were followed-up for 12 months, and no serious complications or recurrence were observed. Conclusions We demonstrated that it is feasible and safe to treat parapelvic renal cysts by ultrasound-guided flexible ureteroscopic incision and drainage. The small sample size and need for further studies were the limitations of our work. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00960-6.
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Chen Y, Wang R, Shen X, Tang J, Shen J, Fang Z, Shi Z, Jin X. Ultrasonography-assisted flexible ureteroscope for the treatment of parapelvic renal cysts: A comparison between the 1470-nm diode laser and the holmium laser. Exp Ther Med 2020; 21:172. [PMID: 33456539 PMCID: PMC7792476 DOI: 10.3892/etm.2020.9603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to compare the efficacy and safety of a flexible ureteroscopic holmium laser incision with flexible ureteroscopic 1470-nm diode laser incision for the treatment of parapelvic renal cysts. The current study collected and analysing the clinical data of 90 independent renal cysts cases retrospectively, including 43 renal cysts cases that received holmium laser surgery (holmium laser group) and 47 renal cysts cases that received 1470-nm diode laser surgery (1470-nm diode laser group). Each group was divided into a thin-walled cyst subgroup and thick-walled cyst subgroup according to cyst wall thickness. Intracapsular hematoma was significantly lower in the 1470-nm diode laser group compared with the holmium laser group (0/47 vs. 4/43; P=0.048). The incision diameter in the 1470-nm diode laser group was significantly larger than the holmium laser group in the thick-walled parapelvic renal cysts subgroup [1.70(1.50,1.90) vs. 1.30(1.25,1.70) cm; P=0.007]. The renal cystic diameter of the two groups was markedly reduced one and six months after surgery. The difference was non-significant in the diameter of the renal cyst in the thin-walled cysts subgroups between the two laser groups 6 months after surgery (1.01±0.38 vs. 1.03±0.53 cm; P=0.454). However, the diameter of the renal cyst in the thick-walled cysts subgroup treated with the 1470-nm diode laser was significantly lower compared with the thick-walled cysts subgroup treated with the holmium laser 6 months after surgery (1.21±0.57 vs. 1.88±0.94 cm; P=0.002). The results demonstrated that the use of a 1470-nm diode laser or holmium laser surgery under a flexible ureteroscope is a safe and effective treatment for parapelvic renal cysts. For thick-walled parapelvic renal cysts, the 1470-nm diode laser appears to exhibit a lower postoperative recurrence rate and better long-term postoperative effects due to its improved haemostatic effect and larger intraoperative incision diameter.
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Affiliation(s)
- Yu Chen
- Department of Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, Zhejiang 313100, P.R. China.,Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Rongjiang Wang
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Xufeng Shen
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Jianer Tang
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Junwen Shen
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Zhihai Fang
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Zhanqin Shi
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's University, The First People's Hospital of Huzhou City, Huzhou, Zhejiang 313100, P.R. China
| | - Xiaodong Jin
- Department of Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, Zhejiang 313100, P.R. China
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Shen J, Chen Y, Wang R. Efficacy and Complication of Flexible Ureteroscopic Holmium Laser Incision for Simple Renal Cysts: A Retrospective Study. J Endourol 2020; 33:881-886. [PMID: 31710258 DOI: 10.1089/end.2019.0515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: The aim of this research was to verify the efficacy and complication of flexible ureteroscopic holmium laser incision for simple renal cysts (SRCs). Patients and Methods: We retrospectively reviewed 116 patients who not only had done flexible ureteroscopic holmium laser incision or laparoscopic decortication for SRC in our institution but also had sufficient data: preoperative information and >1-year follow-up records. The following variables were recorded: age, gender, side, cyst size, location (upper pole, lower pole, and interpolar), blood loss, operative duration, complications during and after surgery, pathology report, and presence or absence of flank pain. The primary endpoint was the efficacy of the treatment; secondary endpoints were safety, pain, and the resolution of other complications. All patients underwent radiologic imaging of the kidneys with a repeated CT, before the operation, 3 and 12 months after surgery. If there were no cysts on the most recent imaging, we defined it as a radiologic success. Results: No statistically significant difference in the background variable in patients of group A (64 patients, flexible ureteroscopic holmium laser incision) and group B (52 patients, laparoscopic decortication) was found, including age, gender, cyst's side, cyst's location, and cyst size before the operation. There were less blood loss by surgeons' evaluation and shorter operative duration (p < 0.001) in group A. In group A, there were three patients who had failed in the first time of operation (two patients failed to place flexible ureteroscope through ureter because of ureteral stricture, and one patient was unable to find the renal cyst in the view of flexible ureteroscope), and no severe postoperative complication was observed. The number of postoperative radiologic failure was five at 3 months and three at 12 months in group A, whereas all the procedures were completed laparoscopically, and no conversion was necessary for group B. But there was one patient who had obvious hematuresis for 1 month after the operation and then it was resolved spontaneously at 3 months. There was only one patient who had a radiologic failure in group B, with the cyst of ∼2 cm at 3 months, and his cyst cannot be seen in CT imaging at 12 months without further treatment. There was no statistically significant difference in the rate of effective operation and complication between the two groups. Conclusion: The operation of flexible ureteroscopic holmium laser incision for SRC had the advantages of less blood loss, short operation time, with a similar rate of operative success and radiologic success after the operation, compared with the process of laparoscopic decortication. It was a good option for urologists to deal with endogenous renal cysts.
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Affiliation(s)
- Junwen Shen
- Department of Urology, The First People's Hospital of Huzhou, Huzhou, China
| | - Yu Chen
- Department of Urology, The First People's Hospital of Huzhou, Huzhou, China
| | - Rongjiang Wang
- Department of Urology, The First People's Hospital of Huzhou, Huzhou, China
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Kang N, Guan X, Song L, Zhang X, Zhang J. Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy. Int Braz J Urol 2018; 44:958-964. [PMID: 30088721 PMCID: PMC6237515 DOI: 10.1590/s1677-5538.ibju.2018.0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/30/2018] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients. Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization. Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stone-free and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases. Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.
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Affiliation(s)
- Ning Kang
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Xing Guan
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Liming Song
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Xiaodong Zhang
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Junhui Zhang
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
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Mao X, Xu G, Wu H, Xiao J. Ureteroscopic management of asymptomatic and symptomatic simple parapelvic renal cysts. BMC Urol 2015; 15:48. [PMID: 26048408 PMCID: PMC4456808 DOI: 10.1186/s12894-015-0042-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 05/21/2015] [Indexed: 12/24/2022] Open
Abstract
Background To investigate feasibility and safety of treating simple parapelvic renal cysts using flexible ureteroscopy with the Holmium laser. Methods Between February 2010 and July 2013, a total of 21 patients, aging from 29 to 71 (49.00 ± 13.23), were diagnosed with parapelvic renal cysts by ultrasonography in combination with contrast-enhanced computer tomography (CT) and intravenous urography (IVU) in the Department of Urology Surgery, People’s Hospital of the Zhejiang province. Fifteen patients were asymptomatic and 6 patients were symptomatic with flank pain. All patients underwent drainage of the cysts using flexible ureteroscopy with Holmium laser. Patients were followed up 1, 3 and 12 months after the operation. Results The intervention was successful in 20 patients and failed in 1 patient who, subsequently successfully underwent a laparoscopic cyst removal. There were no intra-operative and post-operative complications reported. The mean operation time was 27 min (range: 15 to 45 min). The mean hospital stay was 2.6 days (range: 1 to 5 days). Twenty patients were followed up until 15 months after surgery. After such ureteroscopic management, there were no renal cysts detected in 7 patients (35 %) and a reduction in size of the renal cysts was found in 13 patients (65 %). Flank pain subsided in all 6 (100 %) previously symptomatic patients. Conclusions Flexible ureteroscopy with the Holmium laser may be a feasible and effective treatment option in selected patients with simple parapelvic renal cysts. Further prospective randomized studies that compare the procedure to laparoscopic treatments are needed.
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Affiliation(s)
- XiaWa Mao
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
| | - Gang Xu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
| | - HuiFeng Wu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
| | - JiaQuan Xiao
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
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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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