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Kim JH, Jeon UB, Jang JY, Kim TU, Ryu H, Yeom JA, Roh J. Efficacy of single-session 99.5% ethanol sclerotherapy for incidentally found simple renal cysts. Medicine (Baltimore) 2022; 101:e32114. [PMID: 36550842 PMCID: PMC9771283 DOI: 10.1097/md.0000000000032114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Simple renal cysts are the most common masses in the kidney. Most are asymptomatic and are incidentally detected on imaging examinations performed for other reasons. This study aimed to compare the results of 40 and 120 minutes ethanol sclerotherapies that were performed in a single session to treat incidentally found simple renal cysts. We retrospectively reviewed 63 renal cysts in 62 patients treated by single session percutaneous ethanol sclerotherapy. Thirty-one patients with 32 cysts underwent a 40 minutes sclerotherapy (group A), and 31 patients with 31 cysts underwent a 120 minutes retention technique (group B). Under ultrasonographic and fluoroscopic guidance, cystic fluid was completely aspirated, and 50% of the aspirated volume was replaced with 99.5% ethanol (a maximum of 100 mL). Imaging follow-up of the patients was performed 3 months after sclerotherapy. The technical success rates were 100% in both groups. Eighteen patients (29.0%) were symptomatic (flank pain or discomfort). Indications of the other patients were large cysts (>5 cm; 46%) and an increment in the diameter on serial studies (25.4%). A significant difference between the 2 groups in terms of age, cyst diameter, volume of aspirated fluid, volume of injected ethanol, and percentage of reduction in cyst diameter (P > .05) was not found. After treatment, flank pain or discomfort resolved in 17 of 18 (94.4%) symptomatic patients. One patient complained of persistent flank pain; however, no significant abnormality was detected on post-procedural computed tomography images. There were no other complications after therapy in the 2 groups. Single session ethanol sclerotherapy with a 40 minutes retention technique is an effective, safe, and cost-effective method for the treatment of incidentally found simple renal cysts. Although the procedural time was reduced, there was no significant difference in therapeutic efficacy between the 40 and 120 minutes therapies.
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Affiliation(s)
- Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ung Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Radiology, School of Medicine, Pusan National University, Yangsan, Korea
- * Correspondence: Ung Bae Jeon, Department of Radiology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam 50612, Korea (e-mail: )
| | - Joo Yeon Jang
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Radiology, School of Medicine, Pusan National University, Yangsan, Korea
| | - Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jieun Roh
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Zhu XH, Zhang X, Han XW, Zhang P, Wang SY, Li YS, Li G, Chen YH. A controlled clinical study of a two-trocar mini-laparoscopic technique versus the standard laparoscopic technique in treatment of adult renal cysts. Wideochir Inne Tech Maloinwazyjne 2021; 16:728-735. [PMID: 34950269 PMCID: PMC8669990 DOI: 10.5114/wiitm.2021.104173] [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: 12/08/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Laparoscopic renal cyst decortication is currently the best choice for the treatment of simple renal cysts and is widely used in clinical practice. AIM To investigate the safety and clinical efficacy of two-trocar mini-laparoscopic decortication of adult renal cysts. MATERIAL AND METHODS A total of 90 patients were enrolled in the study and randomly divided into two groups: a two-trocar mini-laparoscopic treatment group (M group) and a three-trocar standard laparoscopic treatment group (S group), with 45 patients in each group. RESULTS The average length of hospital stay was shorter, and the demand for postoperative analgesics was less in the M group than in the S group (p < 0.05). The proportion of "very satisfied" patients in the patient physical recovery satisfaction survey was significantly higher in the M group than in the S group (p < 0.05). Of the 45 patients in the M group, 40 successfully underwent surgery. In 3 patients, the two-trocar procedure was converted to a three-trocar procedure due to difficulty in separating perirenal adhesion for visualization. Mini-laparoscopic surgery was converted to classic laparoscopic surgery in 2 patients. In the S group, 44 patients successfully underwent the renal cyst decortication procedure. One patient underwent partial renal resection due to an intraoperative diagnosis of multilocular cystic renal cell carcinoma. Postoperative urine leakage was reported in 3 patients in the M group and two in the S group. CONCLUSIONS Two-trocar mini-laparoscopic treatment of renal cysts is as safe and effective as traditional laparoscopy but is associated with less cosmetic damage, leading to a better physical appearance.
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Affiliation(s)
- Xu-Hui Zhu
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Wu Han
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Si-Yuan Wang
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Sheng Li
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Gao Li
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yuan-Hao Chen
- Institute of Urology, Capital Medical University, Beijing, China
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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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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Abstract
Objective: To investigate the assessment of feasibility and safety of laparoscopic decortication of simple renal cysts in elderly patients.Methods: The data of 114 patients who underwent laparoscopic decortication for simple renal cyst between October 2011 and May 2019 were retrospectively evaluated. Patients' age, gender and ASA scores; operation time; cyst size and location; complications; hospital stays and success rates of operations were recorded.Results: The mean age of the patients were 73.8 ± 8.2 years. Forty-eight (42.1%) of the patients were female and 66 (57.9%) were male. Cysts were localized on the right side in 61 (53.5%) patients and on the left side in 53 (46.5%) patients; and mean cyst size was 72.83 ± 31.13 mm. Also, they were localized on the anterior in 88 (77.2%) patients and on the posterior of the kidney in 26 (22.8%) patients. Preoperative ASA score distributions were ASA-I in 12 patients (10.5%), ASA-II in 31 patients (27.2%), ASA-III in 68 patients (59.7%), and ASA-IV in 3 patients (2.6%). Mean operative time was 41.4 ± 5.6 min. Clavien grade 1 complications were observed in 5 (10.4%) patients. Median hospitalization time was 1 day. No recurrence was occurred in any patient in the postoperative period.Conclusions: Although laparoscopic surgery has some risks and complications for elderly patients, laparoscopic decortication can be applied safely and effectively in treatment of simple renal cyst in that patient population.
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Affiliation(s)
- Ali Akkoç
- Department of Urology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Cemil Aydın
- Department of Urology, Faculty of Medicine, Hitit University, Corum, Turkey
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Han X, Yuan G, Zhu X, Li T, Li Y, Zhang P, Zhang X, Yang B, Yin G. A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts. MINIM INVASIV THER 2020; 30:179-186. [PMID: 32281887 DOI: 10.1080/13645706.2019.1699835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This study aimed to investigate the safety and efficacy of mini-laparoscopy for renal cyst unroofing. MATERIAL AND METHODS Eighty-six patients for treatment of renal cysts that met the selection criteria were included in this study. They were divided into two groups. Forty-five patients underwent cyst unroofing via mini-laparoscopy (Group M), and 43 patients underwent cyst unroofing via standard laparoscopy (Group S). There were no differences between the two groups in terms of sex, age, body mass index or clinical data. Data from the groups were recorded and analyzed. RESULTS The average hospital stays were shorter (p = .039) and postoperative painkiller demand was lower (p = .031) in Group M than in Group S. Forty-one out of 45 procedures in Group M were successful, and all 43 cases in Group S were successfully. With a follow-up period of 0.5 to 5.5 years, there was no significant difference in recovery rate (p = .213). Questionnaires showed that patients in Group M were significantly more satisfied with their cosmetic results than were patients in Group S (p = .041). CONCLUSION Our findings suggest that renal cyst decortications with mini-laparoscopic instruments are as safe and effective as procedures using standard laparoscopic instruments. Cosmetically, the results are better with mini-laparoscopy than with standard laparoscopic unroofing.
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Affiliation(s)
- Xiuwu Han
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Guangtong Yuan
- Department of Urology, People's hospital of Suning County, Suning, P. R. China
| | - Xuhui Zhu
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Tao Li
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Yansheng Li
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Peng Zhang
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xin Zhang
- Institute of Urology, Capital Medical University, Beijing, P. R. China.,Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
| | - Baoshen Yang
- Department of Urology, People's hospital of Suning County, Suning, P. R. China
| | - Genmin Yin
- Department of Urology, People's hospital of Suning County, Suning, P. R. China
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Li X, Qian P. Identification of an exposure risk to heavy metals from pharmaceutical-grade rubber stoppers. J Food Drug Anal 2016; 25:723-730. [PMID: 28911658 PMCID: PMC9328813 DOI: 10.1016/j.jfda.2016.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/09/2016] [Accepted: 07/28/2016] [Indexed: 02/02/2023] Open
Abstract
Exposure to low concentrations of heavy metals and metalloids represents a well-documented risk to animal and human health. However, current standards (European Pharmacopeia [EP], United States Pharmacopoeia [USP], International Organization for Standardization [ISO], YBB concerned with rubber closures) only require testing for Zn in pharmaceutical-grade rubber stoppers and then using only pure water as a solvent. We extracted and quantified heavy metals and trace elements from pharmaceutical-grade rubber stoppers under conditions that might occur during the preparation of drugs. Pure water, saline, 10% glucose, 3% acetic acid (w/v), 0.1 mol/L hydrochloric acid, and diethylenetriaminepentaacetic acid (4 mg/mL, 0.4 mg/mL, and 0.04 mg/mL) were used as extraction agents. We quantified the extracted arsenic, lead, antimony, iron, magnesium, aluminum, and zinc using inductively coupled plasma mass spectrometry. The concentration of extracted metals varied depending on the different extraction solutions used and between the different rubber stopper manufacturers. Rubber stoppers are ubiquitously used in the pharmaceutical industry for the storage and preparation of drugs. Extraction of heavy metals during the manufacturing and preparation of drugs represents a significant risk, suggesting a need for industry standards to focus on heavy metal migration from rubber stoppers.
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Affiliation(s)
- Xianghui Li
- School of Pharmacy, Second Military Medical University, Shanghai 200433,
China
- Shanghai Food and Drug Packaging Material Control Center, Shanghai 201203,
China
- Corresponding author. School of Pharmacy, Second Military Medical University, Shanghai Food and Drug Packaging Material Control Center, Shanghai 200433, China. E-mail address: (X. Li)
| | - Pingping Qian
- Department of Nutrition, Number 411 Hospital of the CPLA, Shanghai 200081,
China
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