Hydatid disease of the urinary tract: evaluation of diagnostic methods

Laparoscopic treatment of unilocular renal hydatid cyst mimicking a simple cyst in a child

A 110 x 70 x 60-mm hydatid cyst in the right kidney of a 5-year-old boy was treated using a laparoscopic approach. The renal hydatid cyst was not identified before the operation. There were no complications related to surgery and therapy. The child was under follow-up for 12 months and there was no evidence of recurrence on ultrasonography and computed tomography during this period. To our knowledge, this is the first case of renal hydatid cyst treated by laparoscopic approach in a child.

Isolated Unilocular Renal Hydatid Cyst: A Rare Diagnostic Difficulty with Simple Cyst

Hydatid disease is endemic in many parts of the world. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% of the cysts occur in the rest of the body. It may develop in almost any part of the body. Although hydatidosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except for eosinophilia which is found in only 50% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain radiography or intravenous urography, and ultrasound or computed tomography cannot always show a hydatidosis as a specific lesion. From these reasons, sometimes it is difficult to differentiate between a unilocular hydatid cyst without mural calcification and a simple renal cyst. So, despite its rarity, hydatid disease should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We present herein a patient with isolated renal hydatid cyst mimicking a simple cyst treated successfully with complete excision.

Isolated renal hydatid disease causing ureteropelvic junction obstruction and massive destruction of kidney parenchyma

Isolated hydatid disease of the kidney is a rare condition that can be challenging to diagnose. We describe a case in which isolated renal hydatid disease obstructed the ureteropelvic junction, resulting in hydronephrosis and complete destruction of the renal parenchyma.

[Hydatid cyst of the kidney]

Hydatidosis is an endemic disease caused by the larval form of Echinococcus Granulosus. Renal involvement represents less than 5% of confirmed cases. It remains clinically silent for a long time, and only presents at the stage of complications. Diagnosis is suspected on the basis of epidemiological, clinical, radiological and biological data. There are various clinical presentations. Hydaturia, which is observed in 10 to 30% of the cases, is the only pathognomonic feature. Diagnostic accuracy has been improved since the wide use of ultrasonography. Computed tomography and magnetic resonance imaging are helpful tools to confirm the diagnosis. The treatment is mainly based on surgery. The resection of the prominent dome remains the standard option as it allows preservation of the kidney. Total nephrectomy should be proposed only in case of renal destruction. The percutaneous management, which includes puncture, aspiration, injection, and reaspiration, can be performed in very selected cases. However, the results of this technique are still under debate.

Unusual localizations of hydatid disease

Hydatid disease is endemic in several Mediterranean countries, posing an important health problem for these countries. The hydatid cyst is characterized by cystic lesions with clear boundaries, which can be observed in all parts of the body. Approximately 70 % of hydatid cysts are situated in the liver, followed by the lung (25 %). The kidneys, spleen, bile ducts, mesentery, soft tissue and brain are less frequent sites. We investigated patients who were treated for hydatid disease in our departments in the last 5 years with respect to localization of the disease, symptoms, surgical intervention, length of hospitalization, diameters of the cyst, and classification by Gharbi. In this retrospective and descriptive study, 176 patients are evaluated who were treated for hydatid disease between 1995 and 1999 in our departments. Of these patients, 14 were included with localization other than in the liver and lungs. Fourteen of the patients diagnosed with unusually located hydatid disease were men, six were women. Their mean age was 41.6 +/- 20.8 years; the length of hospital stay was 7.07 +/- 0.4 days. Overall, 28.6 % of patients with unusually located hydatid cyst had recurrent disease. The time period since last cyst operation was 5.25 +/- 3.5 years. The mean cyst diameter was 96.5 +/- 54.5 mm. According to Gharbi's classification, three cases (21.4 %) of the unusually located hydatid cysts were type I, two (14.3 %) type II, and eight (57.1 %) type III. There was only one case of type IV and no cases of type V. Spleen and kidneys are the organs where hydatid disease is most frequently observed after the liver and lung. It can be observed in all parts of the body including the brain, peritoneum, mesenterium, choledochus, pancreas, bone and muscles. The type of treatment is determined by the localization and type of hydatid disease. Surgical treatment for splenic hydatid cysts is splenectomy. The functional kidney should be saved in non-communicable hydatid disease. Total excision is almost never possible; endocystectomy and drainage procedure should be preferred for hydatid disease of the brain, pancreas and choledochus. Chemotherapy is usually given because of the risk of recurrence; this medical treatment consists in albendazole and mebendazole administration for 3-6 months in the postoperative period.

Isolated renal hydatidosis: experience with 20 cases

PURPOSE

Cystic hydatidosis is an endemic disease caused by the larval form of Echinococcus granulosus. It is mostly evident in the liver and lungs, and renal hydatidosis is uncommon. Renal hydatidosis is usually associated with other organ involvement and isolated disease is extremely rare. We present our experience with isolated renal hydatidosis in 20 patients.

MATERIALS AND METHODS

The charts of 20 patients with isolated renal hydatidosis who were hospitalized in our department during a 25-year period were reviewed retrospectively. The clinical, laboratory and radiologic diagnosis, and treatment of these cases are discussed.

RESULTS

The main clinical symptom was lumbar pain. There was no specific or pathognomonic laboratory test for renal hydatidosis except hydaturia, which was present only in 1 patient (5%). Of radiologic examinations computerized tomography had the highest sensitivity and specificity. Treatment was mainly surgical. We performed nephrectomy in 13 patients, and cystectomy and marsupialization in 6. One patient refused all treatments. There was no postoperative morbidity or mortality.

CONCLUSIONS

Isolated renal hydatidosis is extremely rare. The main problem is the correct preoperative diagnosis. Although radiologic studies and serological-immunological tests support the diagnosis of hydatid disease, a correct preoperative diagnosis is not always easy. The treatment is mainly surgical, and with appropriate diagnosis and treatment the prognosis is good.

Hydatid disease of the urinary tract: review of the management of 9 cases

The aim of this study is to review 9 cases with urinary tract hydatid disease in terms of symptoms, findings, laboratory tests, radiological findings and treatment modalities. There were 7 males and 2 females with a mean age of 33.6 years (range from 7 to 67 years). In 6 patients hydatid cyst was located in the kidney (1 involved the liver), in 2 the cysts were in the paravesical and retrovesical region (1 coexisted bladder tumor) and 1 the cyst was located adrenal gland. The investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), transabdominal ultrasonography (TAUS), intravenous urography (IVU) and computed tomography (CT). All patients underwent various surgical procedures and were followed-up for an average of 3 years (range: 1 month to 5 years) period in terms of complications and recurrence rates. The most common symptom was lumbar or abdominal pain. Eosinophilia was seen in 4 patients (44.4%), IHA positivity in 3 patients (33.3%) and Casoni skin test were positive in 3 patients (33.3%). The most diagnostic method of radiological investigations was abdominal pelvic CT (100%). After surgical treatment, in mean a 3 year (range: 1 month to 5 years) follow-up period, no complication and recurrence were seen. Hydatid disease of the urinary tract is relatively uncommon and is likely to cause considerable diagnostic difficulties for clinicians and radiologists: therefore, it should be born in mind in the differential diagnosis of space-occupying lesions of the urinary tract.

Clinical management of hydatid disease of the urinary tract

This study reviews urinary hydatid disease in seven males and three females (mean age, 32.1 +/- 17.7 years; range, 7-67 years). Cysts were located in the kidney in six cases (one also involved the liver), the paravesical and retrovesical region in two cases (one coexisted with a bladder tumour), the adrenal gland (one case) and in the right parapelvic region (one case). Investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), abdominal ultrasonography, intravenous urography and computed tomography (CT). All patients underwent surgery and were followed for an average of 5.6 years. Lumbar or abdominal pain was the most common symptom. Eosinophilia was seen in five patients (50%), IHA positivity occurred in four patients (40%) and the Casoni skin test was positive in four patients (40%). Abdominal CT was the most useful diagnostic method of radiological investigation (100%). No complications or recurrences were seen on follow-up. Urinary hydatid disease is uncommon and is likely to cause considerable diagnostic difficulties, and should therefore be considered in the differential diagnosis of space-occupying lesions of the urinary tract.

[Giant renal hydatid cyst. Report of a new case]

In this paper, we present a case of huge renal hydatic cyst. We review the literature with regard the clinical presentation, diagnosis methods and surgical technique of treatment.

A solitary hydatid cyst of the retrovesical region

A 70-year-old man presented with a large suprapubic mass. Ultrasonography revealed that the mass was cystic and displaced the bladder anteriorly and superiorly. Computed tomography suggested that the mass could be an echinococcal cyst. Computed tomography also showed that the patient had bilateral hydroureteronephrosis. Echinoccocal haemagglutination was positive at 1:320 dilution. The patient underwent surgical exploration during which the cyst was found to be located in the retrovesical region. The cyst was completely excised and the pathologic examination confirmed the diagnosis.

A case of pure renal hydatid cyst without multiple organ involvement

Hydatid disease of the urinary tract is very rare. We report a case of pure renal hydatid cyst, with its clinical presentation and management.

Diagnosis and treatment of renal hydatid disease: presentation of four cases

Hydatid disease of the urinary tract is uncommon, accounting for only 2% to 1% of all hydatid diseases. We report 4 patients with hydatid cystic disease of the kidney. Nephrectomy was performed on 1 patient because of the destruction of renal parenchyma by the hydatid cyst. The other 3 patients were treated by cystectomy to preserve the normal renal parenchyma. In these cases, Casoni's intradermal test and indirect hemagglutination (IHA) test were not found to be helpful in the diagnosis, and eosinophilia was not significant. Diagnostic features of hydatid cysts were mixed echogenicity on ultrasonography, and multivesicular cyst with mixed density on computerized tomography (CT). CT was the most useful and specific investigation. No complications were noted during the first 3 months of the follow-up. Despite its rarity, hydatid disease should be considered in the differential diagnosis of space-occupying lesions of the urinary tract. Parenchyma-sparing surgery (cystectomy, partial nephrectomy) or nephrectomy are the main treatment modalities.

Hydatid disease of the kidney: evaluation and features of diagnostic procedures

We discuss 8 patients with hydatid cystic disease of the kidney. Diagnostic procedures included eosinophil count, Casoni's skin test, Ghedini-Weinberg complement fixation test, abdominal x-ray, excretory urogram, ultrasonography and computerized tomography. The combined findings of these different modalities aid greatly in establishing the correct diagnosis.

Management of hydatid cysts of the urinary tract

Eleven patients with hydatid disease of the urinary tract have been seen in the last 5 years. Seven patients had cysts of the kidneys and 4 had large retrovesical hydatids. Seven of the 8 patients with renal hydatids presented with loin pain and mass. Three patients with renal communicating hydatids also presented with haematuria which was due to passing "grape skin" (hydatid membrane) in the urine. Two patients with retrovesical hydatids had bladder outflow obstruction and 2 had bilateral ureteric obstruction leading to uraemia. Eight of 11 patients had associated hydatids of other organs such as the liver (4 patients), peritoneal cavity (2) and lungs (1). Computed tomography was the most useful and specific investigation. In both renal and pelvic (retrovesical) hydatid cysts, endocystectomy with either partial excision or plication of the ectocyst is the standard treatment. In renal communicating hydatids the options are either nephrectomy (partial or total) or endocystectomy with closure of the communication. The use of cryocone and scolicidal agents is mandatory during surgery.