1
|
Tseng WH, Hsieh CC, Huang SK, Liu CL, Lee KH, Hsieh KL, Chen ZH, Chiu AW, Li CF, Shiue YL. Advantages of retrograde intrarenal incision versus laparoscopic surgery in management of pararenal cysts: a single-center experience. Int Urol Nephrol 2024; 56:1307-1313. [PMID: 38044410 DOI: 10.1007/s11255-023-03881-x] [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: 08/08/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Renal cysts are typically a benign condition, and parapelvic cysts are a type of renal cyst that occur adjacent to the renal pelvis or renal sinus. Parapelvic cysts can increase the risk for injury to adjacent organs or urine leakage during laparoscopic surgery. Flexible ureteroscopes with laser assistance were used to make internal incisions in cysts. Perioperative outcomes of this method were compared with those of laparoscopic surgery. METHODS Eight-three patients, who underwent surgical treatment for renal cysts at the authors' medical center between January 2019 and June 2022, were evaluated. Two patients were excluded because they originally opted for RIRS but subsequently converted to laparoscopic surgery. Patients were divided into 2 groups based on surgery type: laparoscopic; and RIRS for internal incision. Outcomes in both groups were analyzed. RESULTS Of the 81 patients analyzed, 60 [74% (group 1)] underwent laparoscopic surgery and 21 [26% (group 2)] underwent RIRS for internal incision. The median operative durations for groups 1 and 2 were 87 and 56 min, respectively (p < 0.001). Relative to RIRS, laparoscopic surgery resulted in greater postoperative painkiller use (laparoscopic surgery versus [vs.] RIRS, 43% vs. 19%; p = 0.047). The median length of hospital stay was 2 and 1 days, respectively (p < 0.001). CONCLUSIONS RIRS demonstrated several advantages over laparoscopic surgery for the internal incision of parapelvic cysts, including shorter operative duration, shorter hospital stay, and less postoperative pain control. These findings may guide the selection of appropriate surgical approaches for patients with renal cysts.
Collapse
Affiliation(s)
- Wen-Hsin Tseng
- Institute of Biomedical Science, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Chia-Chih Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC.
| | - Steven K Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Chien-Liang Liu
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
- Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Kun-Lin Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Zhi-Hao Chen
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Allen W Chiu
- Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chien-Feng Li
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Science, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Institute of Precision Medicine, College of Medicine, National Sun Yat-Sen University, No. 70, Lienhai Rd., Kaohsiung, 80424, Taiwan, ROC.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Meng X, Mi Q. Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts: A retrospective study. Int Braz J Urol 2022; 48:842-849. [PMID: 35838511 PMCID: PMC9388182 DOI: 10.1590/s1677-5538.ibju.2022.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background: We aimed to investigate the clinical efficacy and safety of transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts. Materials and Methods: Between October 2017 and April 2021, the clinical data of 65 patients with parapelvic renal cysts were evaluated retrospectively. Thirty-one patients with parapelvic cysts (Group 1) underwent a transurethral flexible ureteroscopic incision and drainage with a holmium laser, whereas the other 34 patients (Group 2) underwent retroperitoneal laparoscopic unroofing. The patients' clinical features were documented. The surgery time, intraoperative blood loss, hospitalization time, complications and cyst size were recorded and statistically assessed one year following the procedure. Results: All of the patients were successfully treated with flexible ureteroscopic incision and drainage or retroperitoneal laparoscopic unroofing. In terms of clinical parameters, such as age, gender, BMI, location, cyst size, and Bosniak classification of renal cysts, no statistically significant difference was detected between Groups 1 and 2. Compared to the control group (Group 2), Group 1 demonstrated a shorter surgery duration, less intraoperative blood loss, and a shorter hospital stay (p < 0.001). However, no significant differences in complications and cyst size were observed between the two groups one year after the surgery (p > 0.05). Conclusions: Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts has obvious advantages over traditional surgery, and is worthy of advancement and application, but its long-term effect needs further follow-up studies.
Collapse
Affiliation(s)
- Xiangjun Meng
- Department of Urology, Dongguan People's Hospital, Dongguan, Guangdong, P.R. China
| | - Qiwu Mi
- Department of Urology, Dongguan People's Hospital, Dongguan, Guangdong, P.R. China
| |
Collapse
|
4
|
Huang T, Yang Q, Wu H, Zhu D, Hu Y, Xu M. Clinical efficacy of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts. BMC Surg 2022; 22:315. [PMID: 35964028 PMCID: PMC9375338 DOI: 10.1186/s12893-022-01763-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Objective This study aims to investigate the efficacy and safety of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts, and to review recently published relevant literature. Method This is a retrospective study in which the clinical data of 47 patients who underwent flexible ureteroscopic holmium laser incision and internal drainage of parapelvic cysts in our center from March 2017 to March 2021 were retrospectively analyzed. A literature search was conducted to review and summarize relevant reports on endoscopic treatment of parapelvic cysts published in the past 10 years. Results Among 47 patients with parapelvic cysts who underwent flexible ureteroscopic holmium laser incision and internal drainage, 12 (25.53%) cases had a typical cyst wall bulging into the collecting system under flexible ureteroscope. As the cyst wall was thin and translucent in these cases, ultrasound was not used during the operation. The cysts of the remaining 35 patients were located with the aid of intraoperative real time ultrasound, and all underwent successful operation. No serious surgical complications occurred after surgery. The patients were followed up for 12–24 months after operation. The cyst in one case was observed larger than its original size before operation, so recurrence was considered. In another two cases, the diameters of the cysts were more than half of their original diameters before operation. Thus, the efficacy was poor in the three cases. For the remaining 44 cases, there was no obvious cyst observed or the diameter of the cysts was less than half their preoperative level. Conclusion The approach of ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts is safe and effective, which helps to solve the problem of localization of atypical parapelvic cysts on endoscopic findings.
Collapse
Affiliation(s)
- Ting Huang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Qing Yang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Haixiao Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Desheng Zhu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Yang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Min Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Huang B, Lu G, Tu W, Zhao Y, Wang Y, Zhang L, Shao Y, Wang D. Factors Influencing Surgical Outcome in Retrograde Management of Parapelvic Renal Cysts. J Endourol 2020; 35:466-472. [PMID: 33050738 DOI: 10.1089/end.2020.0508] [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: 11/13/2022] Open
Abstract
Objective: To investigate the outcomes of retrograde flexible ureteroscopy in managing parapelvic renal cysts and speculate the factors affecting therapeutic efficacy. Methods: Thirty-eight patients with parapelvic renal cysts were recruited and underwent retrograde flexible ureteroscopy using holmium laser. Parapelvic cysts were divided into peripheral type and central type based on the position of cyst convex to the perirenal tissue. Feasibility and safety were retrospectively evaluated, and cases were analyzed to detect their distinctive characteristics. Independent-sample t-test and chi-square test were undertaken for continuous variables and categorical variables, respectively. Results: Radiologic evidence of success was achieved in 31 (81.58%) cases after a mean follow-up of 14.4 months (range 6-26 months). No significant perioperative complications were identified. There were seven cases with features of peripherally located parapelvic cyst. Four cysts shown as irregular protrusion were unable reduce to less half of previous size. Reductions were recorded in the other three patients with spherically peripheral protrusion. There was significant difference between these two types (p = 0.029). Among the 31 patients with centrally located parapelvic cyst, 28 of these have simple cysts that achieved radiologic success and 3 of the 31 patients were identified as failed cases indicated by renal pelvis enveloped by cyst on radiologic investigation. The success rate of simple cysts was significantly higher than that of the later type (p < 0.001). Conclusion: The location and shape of parapelvic cyst may play a critical role in the radiologic outcome of internal incision and patients with simple central or spherical peripheral cyst may benefit more from retrograde flexible ureteroscopy combined with laser incision.
Collapse
Affiliation(s)
- Baoxing Huang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guoliang Lu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weichao Tu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yang Zhao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yuanchun Wang
- Monash Health, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Lin Zhang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,Victorian Comprehensive Cancer Centre, The University of Melbourne Centre for Cancer Research, Parkville, Australia
| | - Yuan Shao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dawei Wang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Urology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
7
|
Santiapillai J, Agrawal S. Combined flexible URS and percutaneous ‘through and through’ puncture of an intra-renal cyst with internalisation of drainage, to treat calyceal obstruction and recurrent stones. Urol Case Rep 2020; 30:101125. [PMID: 32042595 PMCID: PMC7000792 DOI: 10.1016/j.eucr.2020.101125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022] Open
Abstract
A 61 year old gentleman had a large renal cyst, thought to be causing a ‘pseudo-hydrocalyx’ leading to recurrent stones. Definitive treatment with laparoscopic deroofing was planned, however intra-operatively this was abandoned due to complex anatomy and scared adherent tissue. Patient went on to have a flexible ureteroscopy and ‘through and through’ puncture of an intrarenal cyst with PCNL to treat his stones and renal cyst simultaneously. CT scan 12 months later showed no new stone formation and no residual cyst. Percutaneous puncture of a renal cyst combined with flexible ureteroscopy is an effective method when treating large renal cysts.
Collapse
|