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Capuano I, Buonanno P, Riccio E, Crocetto F, Pisani A. Parapelvic Cysts: An Imaging Marker of Kidney Disease Potentially Leading to the Diagnosis of Treatable Rare Genetic Disorders? A Narrative Review of the Literature. J Nephrol 2022; 35:2035-2046. [PMID: 35749008 DOI: 10.1007/s40620-022-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
Simple renal cysts are a common finding during abdominal imaging assessment. The incidence increases with age and it is higher in male gender. Parapelvic cysts are a subset of simple cysts that arise within the renal parenchyma, adjacent to the renal sinus, characterized by being generally single, larger, and incompletely surrounded by renal parenchyma. Noteworthy, parapelvic cysts are a rare and understudied condition which, although considered clinically insignificant due to the absence of influence on renal function, still have a controversial aetiopathogenesis. On the other hand, urological management and differential diagnosis have been thoroughly investigated. The aim of our review is to provide an overall vision on this rare condition, usually misdiagnosed and underestimated, on the basis of more recent data. An accurate differential diagnosis of parapelvic cysts can lead to the identification of treatable conditions such as Fabry disease, autosomal dominant polycystic kidney disease, polycystic liver disease and tuberous sclerosis complex disease.
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Affiliation(s)
- Ivana Capuano
- Department of Public Health, Chair of Nephrology "Federico II", University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Chair of Nephrology "Federico II", University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Haghdani S, Mohammadi Sichani M, Safi R, Khorrami M, Alizadeh F, Izadpanahi M. Does the simple renal cyst treatment improve renal function: A pilot study. Adv Biomed Res 2022; 11:38. [PMID: 35814296 PMCID: PMC9259450 DOI: 10.4103/abr.abr_131_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/29/2020] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The current study aims to assess the effects of the large simple renal cyst (SRC) surgery on renal function for the first time. Materials and Methods: This case-series study included 22 patients with larger than 50 mm single SRC who underwent laparoscopic cyst unroofing surgery. Twenty-four-hour urinary protein, creatinine, and volume along with plasma creatinine and estimated glomerular filtration rate (GFR) were measured in patients before and 1 month after surgery. Patients underwent abdominopelvic computed tomography-scan without contrast and parenchymal thickness diameter adjacent to the cyst was measured before and after surgery. Results: Mean age and weight of patients were 52.2 ± 8.9 years and 77 ± 10.9 akg, respectively. There was no significant difference between plasma creatinine and GFR before and after surgery (P = 0.25 and 0.37, respectively). Twenty-four-hour urinary volume, creatinine, and protein before and after surgery revealed no significant changes (P = 0.37, 0.08, and 0.31, respectively). The mean improvement of parenchymal thickness diameter after surgery was 10.4 ± 0.7 mm which was statistically significant (P = 0.001). However, it was not correlated with the mean estimated GFR change (r = 0.349, P = 0.13). Conclusions: Although laparoscopic unroofing of renal cyst recovered renal parenchymal thickness noticeably, it did not improve renal function significantly; therefore, the latter factor lonely should not be considered a reason for surgery decision. Observation can be chosen as a safe treatment strategy in large SRCs without concern about renal function.
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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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Brown D, Nalagatla S, Stonier T, Tsampoukas G, Al-Ansari A, Amer T, Aboumarzouk OM. Radiologically guided percutaneous aspiration and sclerotherapy of symptomatic simple renal cysts: a systematic review of outcomes. Abdom Radiol (NY) 2021; 46:2875-2890. [PMID: 33544165 DOI: 10.1007/s00261-021-02953-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
Simple renal cysts are common benign lesions of the kidney with up to 4% of patients developing symptoms necessitating intervention including pain and haematuria. We conducted a systematic review of the literature to determine the efficacy and safety of aspiration-sclerotherapy of symptomatic simple renal cysts. A systematic review using Cochrane guidelines was conducted on published literature from 1990 to 2020. RCTs, cohort studies and case series meeting the inclusion criteria were reviewed and cumulative analysis of outcomes was performed. A total of 4071 patients from 57 studies underwent aspiration ± sclerotherapy for their simple renal cysts. 87.7% of patients who had aspiration with sclerotherapy demonstrated 'treatment success' with a >50% reduction in cyst size and complete resolution of symptoms. 453 minor, transient complications occurred (11.2%) whilst a major complication rate of less than 0.1% (4 patients) was reported. Pooled analysis of all available current literature demonstrates that aspiration-sclerotherapy is a safe and effective first-line therapy for symptomatic simple renal cysts. Although we are unable to compare those undergoing aspiration alone to aspiration-sclerotherapy, it is evident the use of a sclerosing agent is integral to treatment success; however, the optimum agent, volume, injection frequency, and dwelling time are yet to be defined. Cyst size should be considered when discussing treatment options; however, we conclude it reasonable for aspiration-sclerotherapy to be used in the first instance in all cases of symptomatic simple renal cysts. Furthermore, we propose definitions of treatment outcome measures in order to allow direct comparative analysis across future studies.
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Affiliation(s)
- Dominic Brown
- Department of Urology, Broomfield Hospital, Chelmsford, UK.
| | - Sarika Nalagatla
- Department of Urology, University Hospital Monklands, Glasgow, UK
| | - Thomas Stonier
- Department of Urology, St George's Hospital, Tooting, London, UK
| | | | - Abdulla Al-Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tarik Amer
- Department of Urology, University Hospital Monklands, Glasgow, UK
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- University of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, Scotland, UK
- College of Medicine, Qatar University, Doha, Qatar
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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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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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Using Polidocanol in Treatment of Simple Renal Cyst. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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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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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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Mancini V, Cormio L, d'Altilia N, Benedetto G, Ferrarese P, Balzarro M, Defidio L, Carrieri G. Retrograde Intrarenal Surgery for Symptomatic Renal Sinus Cysts: Long-Term Results and Literature Review. Urol Int 2018; 101:150-155. [PMID: 29719301 DOI: 10.1159/000488685] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To report the long-term multicenter experience with retrograde intrarenal holmium-laser incision (RIR-HoLI) in the management of symptomatic renal sinus cysts (RSCs). In the literature, RIR-HoLI has been shown to be a safe and effective treatment, but there are only a few reports regarding long-term results and reproducibility of this procedure. MATERIAL AND METHODS From June 2010 to June 2015, 14 patients with symptomatic RSCs underwent RIR-HoLI. The mean age was 52.1 ± 11.28 years (range 28-77) and the mean cyst size was 53.2 ± 14.23 mm (range 35-90). In all cases, contrast-enhanced computer tomography (CT) showed compression of the renal pelvis by the cyst (no malignancy). Surgical outcome was assessed in terms of symptoms improvement (measured by Visual Analogue Scale [VAS] for pain) and renal ultrasound findings at 3-6-12 months postoperatively and then yearly. CT scan was carried out at 12 months follow-up. RESULTS RIR-HoLI was successful in all patients. The mean operative time was 47.8 ± 13.54 min (range 30-80) and mean hospital stay was 3.5 days (range 2-5). There were 2 Clavien grade II complications (flank pain and urgency delaying discharge). After surgery, all patients -became asymptomatic (VAS score change, p = 0.0001). One patient had persistence of a small cyst (10 mm). Mean follow-up is 44 ± 17.24 months (range 24-84); all patients remained asymptomatic, with no signs of recurrence. CONCLUSIONS RIR-HoLI proved to be a safe and effective treatment for symptomatic RSCs. In our experience, it provided excellent long-term results and was reproducible at 4 different -institutions.
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Affiliation(s)
- Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Nicola d'Altilia
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Benedetto
- Department of Urology, San Bortolo Hospital, ULSS 8 Berica, Vicenza, Italy
| | - Paolo Ferrarese
- Department of Urology, San Bortolo Hospital, ULSS 8 Berica, Vicenza, Italy
| | | | | | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
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Liang B, Xie YG, Xu XP, Hu CH. Diagnosis and treatment of submucous myoma of the uterus with interventional ultrasound. Oncol Lett 2018; 15:6189-6194. [PMID: 29616100 PMCID: PMC5876458 DOI: 10.3892/ol.2018.8122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/07/2017] [Indexed: 11/13/2022] Open
Abstract
The value of interventional ultrasound in the diagnosis and treatment of submucous myoma of the uterus was assessed to study the ultrasonographic features of modified sonohysterography for submucous polyp of uterus. A total of 25 patients diagnosed preliminarily as submucous myoma of the uterus via conventional ultrasound examination from June 2014 to December 2016 were enrolled in the study. The diagnosis was made via the comprehensive analysis of ultrasound-guided modified SHG, followed by ultrasound-guided needle biopsy and sclerotherapy of tumor. After modified SHG and ultrasound-guided needle biopsy, 96% (24/25) cases were confirmed pathologically as submucous myoma of the uterus. After treatment, the maximum diameter of myoma in patients with submucous myoma of uterus was significantly different, and the volume of myoma was significantly reduced. After treatment, the clinical symptoms of patients with submucous myoma of the uterus were obviously improved compared to before treatment (P<0.05). It was found in the follow-up after treatment that a small number of patients suffered from mild abdominal pain, increased secretion, slight vaginal bleeding, cold sweat, pale complexion, dizziness and other symptoms, which, however, disappeared after treatment for about 1 week. The score of 36 item Short-Form Health Survey Questionnaire of patients with submucous myoma of the uterus was significantly different before and after treatment (P<0.05). Interventional ultrasonography can effectively diagnose the submucous myoma of uterus. The treatment of submucous myoma of uterus with ultrasound-guided intratumor injection of lauromacrogol is characterized by simple operation, which can effectively reduce the tumor diameter and volume, improve the blood flow in patients, reduce the postoperative adverse reactions and alleviate the patient's pain, so it is a new type of minimally invasive treatment method of submucous myoma of the uterus, and it is worthy of clinical promotion and application.
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Affiliation(s)
- Bo Liang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China.,Department of Ultrasonography, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Yang-Gui Xie
- Department of Ultrasonography, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xiao-Ping Xu
- Department of Ultrasonography, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Chun-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Wang R, Wang N, Tang J, Chen Y, Gao J. The safety and efficacy of MPR-CTU combined with precise intraoperative ultrasonography guided flexible ureteroscope in the treatment of renal cystic disease. Exp Ther Med 2017; 15:283-287. [PMID: 29375688 PMCID: PMC5763662 DOI: 10.3892/etm.2017.5379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022] Open
Abstract
The safety and efficacy of multi-planar reconstruction (MPR) image post-processing technique-computed tomography (CT) urography (CTU) combined with precise intraoperative ultrasonography guided flexible ureteroscope in renal cyst incision and drainage in the treatment of cystic diseases of kidney were evaluated. A total of 68 patients were randomly divided into control and observation group (n=34). All the patients were treated with renal cyst incision and drainage under flexible ureteroscope. The control group was under ultrasound guidance. The observation group was combined with MPR-CTU, the safety and efficacy was compared. There was no significant difference between the two groups in the success rate and the time of cyst treatment (P>0.05). The incidence of intraoperative and postoperative complications of the observation group was significantly lower than that of the control group. After 1 month follow-up, the total effective rate of the observation group was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion MPR-CTU technique combined with intraoperative ultrasonography to guide cyst incision and drainage under flexible ureteroscope for renal cystic disease has a high safety and efficacy, and it is worthy of clinical application.
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Affiliation(s)
- Rongjiang Wang
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's College, Huzhou, Zhejiang 313000, P.R. China
| | - Ning Wang
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's College, Huzhou, Zhejiang 313000, P.R. China
| | - Jianer Tang
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's College, Huzhou, Zhejiang 313000, P.R. China
| | - Yu Chen
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's College, Huzhou, Zhejiang 313000, P.R. China
| | - Jianguo Gao
- Department of Urology, The First Affiliated Hospital of Huzhou Teacher's College, Huzhou, Zhejiang 313000, P.R. China
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Cho YJ, Shin JH. Comparison of acetic acid and ethanol sclerotherapy for simple renal cysts: clinical experience with 86 patients. SPRINGERPLUS 2016; 5:299. [PMID: 27066335 PMCID: PMC4783315 DOI: 10.1186/s40064-016-1971-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/03/2016] [Indexed: 11/10/2022]
Abstract
Background
To compare the efficacy and treatment session numbers of acetic acid to that of ethanol sclerotherapy for the treatment of simple renal cysts. Between February 2004 and June 2013, 86 patients with simple renal cysts underwent percutaneous aspiration and injection of 50 %-acetic-acid (42 cysts) and 95 %-ethanol (44 cysts). The patient demographics, volume reduction rate, number of treatment sessions, and complications were then analyzed. Results The volume reduction rate was 94.1 ± 7.6 % in the 50 %-acetic acid group and 94.7 ± 11.7 % in the 95 %-ethanol group, and without a statistical difference. The rates of complete remission, partial remission, and no response were 57.1, 42.9 and 0 %, respectively, for the acetic acid group, and 70.5, 25.0, and 4.5 %, respectively, for the ethanol group. No statistical difference was observed between the two groups. Compared to the acetic acid group, the ethanol group had a higher number of treatment sessions, i.e. 1.10 ± 0.30 in the acetic acid group and 1.80 ± 0.79 in the ethanol group. Mild flank pain was a minor complication that occurred in both groups. Conclusions Acetic acid seems to have equivalent sclerosing effects on simple renal cysts compared with those of ethanol despites of fewer treatment sessions.
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Affiliation(s)
- Young Jun Cho
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegeum-dong, Busanjin-gu, Busan, 614-725 Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, Research Institute of Radiology, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul, 138-736 Korea
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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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Küçük EV, Tahra A, Bindayi A, Suçeken FY, Önol FF, Boylu U. Long-term functional results of aspiration and sclerotherapy with ethanol in patients with autosomal dominant polycystic kidney disease: a non-randomized pilot clinical study. Int Urol Nephrol 2016; 48:457-63. [PMID: 26759329 DOI: 10.1007/s11255-015-1211-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the long-term effect of aspiration and sclerotherapy treatment on the pain control, blood pressure regulation, and quality of life (QoL) in patients with autosomal dominant polycystic disease (ADPKD). METHODS Twenty-five ADPKD patients with a total of 32 dominant cysts were treated with ultrasound guidance percutaneous aspiration and 96% ethanol injection, between 2002 and 2014. Twenty-one dominant cysts of 16 patients who had a minimum of 10-year follow-up were included in this study. The level of pain [visual analog score (VAS)], narcotic usage, blood pressure and serum creatinine level, QoL questionnaire, and radiological dominant cyst size was evaluated before and after procedure, retrospectively. RESULTS The mean dominant cyst size was even smaller after follow-up of 10 years. Mean dominant cyst size was 7.2 ± 2.3 cm before the procedure and 0.9 ± 0.9 and 3.3 ± 1.2 cm after the one- and 10-year follow-ups, respectively (p < 0.05). VAS and QoL scores were improved after 10 years of follow-up. There was no relation between cyst size and VAS score as well as QoL questionnaire score. End-stage renal disease occurred in 50%, and there was no significant improvement in blood pressure of these patients. CONCLUSIONS Aspiration and sclerotherapy with ethanol is a minimal-invasive, safe, and inexpensive outpatient treatment method with acceptable short- and long-term results in ADPKD patients. Aspiration and sclerotherapy with ethanol can be an option for patients with ADPKD.
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Affiliation(s)
- Eyüp Veli Küçük
- Clinic of Urology, Ümraniye Training and Research Hospital, Adem Yavuz cd. No. 1, 34766, Istanbul, Turkey.
| | - Ahmet Tahra
- Clinic of Urology, Ümraniye Training and Research Hospital, Adem Yavuz cd. No. 1, 34766, Istanbul, Turkey
| | - Ahmet Bindayi
- Clinic of Urology, Ümraniye Training and Research Hospital, Adem Yavuz cd. No. 1, 34766, Istanbul, Turkey
| | - Ferhat Yakup Suçeken
- Clinic of Urology, Ümraniye Training and Research Hospital, Adem Yavuz cd. No. 1, 34766, Istanbul, Turkey
| | - Fikret Fatih Önol
- Clinic of Urology, Ümraniye Training and Research Hospital, Adem Yavuz cd. No. 1, 34766, Istanbul, Turkey
| | - Uğur Boylu
- Clinic of Urology, Ümraniye Training and Research Hospital, Adem Yavuz cd. No. 1, 34766, Istanbul, Turkey
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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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Dell'Atti L. Comparison between the use of 99% ethanol and 3% polidocanol in percutaneous echoguided sclerotherapy treatment of simple renal cysts. Urol Ann 2015; 7:310-4. [PMID: 26229316 PMCID: PMC4518365 DOI: 10.4103/0974-7796.152026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/10/2014] [Indexed: 11/04/2022] Open
Abstract
AIM In this study, we compared and valued efficacy and safety of percutaneous echoguided sclerotherapy (PES) using 3% polidocanol with that using 99% ethanol in the treatment of patients with simple renal cysts. MATERIALS AND METHODS PES was performed for 65 simple renal cysts. Under ultrasonographic guidance the cyst was punctured using an 18 gauge needle. Sclerotherapy was performed with ethanol in 55% (36/65) of cases and with polidocanol in the remaining 45% (29/65). Patients were followed up with an ultrasound examination at 4 months, 8 months, and then at yearly intervals. A reduction of 50% or greater in cyst diameter was considered successful. RESULTS The median followup period for the ethanol and polidocanol groups was 24.6 and 22.8 months, respectively. The successful outcome ratio of the polidocanol group was significantly higher (90% vs. 61%, respectively) than the one of the ethanol group (P = 0.003). The partial regression of the ethanol and polidocanol groups were 6% versus 7%, respectively. The failure ratio of the polidocanol group was significantly lower (3% vs. 33%, respectively) than that of the ethanol group (P = 0.004). Neither infectious complications nor hyperthermia occurred in all treated cases. However, these methods are not completely free from symptoms. All these symptoms disappeared few hours after the procedure. CONCLUSIONS Polidocanol is a safe and effective sclerosing agent for renal cysts, with superior clinical results than ethanol. Therefore, polidocanol can be an alternative to ethanol in sclerotherapy of renal cysts.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, Arcispedale "S. Anna", Cona 44124, Ferrara, Italy
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Renal Embolization and Urothelial Sclerotherapy for Recurrent Obstructive Urosepsis and Intractable Haematuria from Upper Tract Urothelial Carcinoma. Cardiovasc Intervent Radiol 2015. [PMID: 26206598 DOI: 10.1007/s00270-015-1184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Management of intractable haematuria and obstructive urosepsis from upper tract urothelial carcinoma can be problematic in patients not suitable for surgery, chemotherapy or radiotherapy. Interventional radiology techniques provide alternative approaches in this setting, such as complete kidney embolization to cease urine output, percutaneous nephrostomy, antegrade injection of sclerotherapy agents and sterilisation of the upper collecting system. Related approaches have been successfully employed to sclerose renal cysts, lymphoceles, chyluria and intractable lower tract haemorrhage. No reports of percutaneous, antegrade sclerotherapy in the upper urinary tract have previously been published. We present a case of recurrent haematuria and obstructive urosepsis caused by invasive upper tract urothelial carcinoma in a non-operative patient, which was treated with renal embolisation and percutaneous upper tract urothelial sclerotherapy.
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Lanchon C, Fiard G, Long JA. [Management of cystic renal masses: Review of the literature]. Prog Urol 2015; 25:675-82. [PMID: 26138648 DOI: 10.1016/j.purol.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The expansion of renal cysts diagnosis in the population entails to learn how to properly identify and treat potentially malignant lesions. The aim of this review article is to discuss anatomical and pathological characteristics as well as treatment of cystic renal tumors. METHOD A literature review of Medline publications on renal cysts and cystic tumors was conducted. Prospective and retrospective studies in adults, and previous reviews were analyzed. RESULTS Bosniak classification of renal cysts is used worldwide among urologists and radiologists to categorize cystic lesions according to their potential malignancy. There is a 0, 15, 50 and 95 % chance of cancerous cells in Bosniak I, II, III, and IV, respectively. The most frequent pathology is renal cell carcinoma, usually low grade and low stage. Category IIF cysts (F for follow-up) have a 25 % chance of malignancy and require surveillance at 6 months and regularly for 5 years. The follow-up can be done with CT imaging, MRI or contrast enhanced ultrasonography. Cyst biopsy, which was not recommended for a long time, could prevent 40 % of unnecessary surgeries for benign lesions. Bosniak category I and II cysts can be treated if symptomatic, by sclerotherapy or laparoscopic deroofing of the cyst. Category III and IV lesions must be treated as malignant tumors with security margins. CONCLUSION Diagnosis and treatment of Bosniak category IIF renal cysts remain the primary challenge for physicians in cystic renal tumor management. Biopsies of renal cysts seem reliable, with no risk of malignant cell dissemination.
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Affiliation(s)
- C Lanchon
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France
| | - G Fiard
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France
| | - J-A Long
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France.
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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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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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