Management of renal cysts

Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential

BACKGROUND

Up until now, no research has been reported on the association between the clinical growth rate of multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and computed tomography (CT) imaging characteristics. Our study sought to examine the correlation between them, with the objective of distinguishing unique features of MCRNLMP from renal cysts and exploring effective management strategies.

AIM

To investigate optimal management strategies of MCRNLMP.

METHODS

We retrospectively collected and analyzed data from 1520 patients, comprising 1444 with renal cysts and 76 with MCRNLMP, who underwent renal cyst decompression, radical nephrectomy, or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution. Detection of MCRNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology.

RESULTS

Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP. Precisely, it comprises 1.48% of all cases involving simple renal cysts, 5.26% of those with complex renal cysts, and a noteworthy 12.11% of renal tumors coexisting with renal cysts, indicating a statistically significant difference (P = 0.001). Moreover, MCRNLMP constituted a significant 22.37% of the patient population whose cysts demonstrated a rapid growth rate of ≥ 2.0 cm/year, whereas it only represented 0.66% among those with a growth rate below 2.0 cm/year. Of the 76 MCRNLMP cases studied, none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis. In the remaining 67 patients, who were actively monitored over a 3-year postoperative period, only one showed suspicious recurrence on CT scans.

CONCLUSION

MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators. In treating MCRNLMP, partial nephrectomy is preferred, while radical nephrectomy should be minimized. After surgery, active monitoring is advisable to prevent unnecessary nephrectomy.

Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts

Background

A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to transplantation may help optimize organ usage without recurrence of malignancy or increased risk of complications.

Methods

We retrospectively analyzed all recipients of a living or deceased donor graft between February 2009 and October 2022 in which a PN was performed prior to transplant due to the presence of one or more concerning growths. Donor and recipient demographics, perioperative data, donor allograft pathology, and recipient outcomes were obtained.

Results

Thirty-six recipients received a graft in which a PN was performed to remove suspicious masses or cysts prior to transplant. Majority of pathologies turned out to be a simple renal cyst (65%), followed by renal cell carcinoma (15%), benign multilocular cystic renal neoplasm (7.5%), angiomyolipoma (5%), benign renal tissue (5%), and papillary adenoma (2.5%). No renal malignancy recurrences were observed during the study period (median follow-up: 67.2 months). Fourteen complications occurred among 11 patients (30.6% overall) during the first 6mo post-transplant. Mean eGFR (± standard error) at 36 months post-transplant was 51.9 ± 4.2 ml/min/1.73 m2 (N = 23). Three death-censored graft losses and four deaths with a functioning graft and were observed.

Conclusion

PN of renal grafts with suspicious looking masses or cysts is a safe option to optimize organ usage and decrease the kidney non-use rate, with no observed recurrence of malignancy or increased risk of complications.

Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts-An innovative ambulatory surgery mode

Objective

This study was designed to evaluate the feasibility, efficacy, and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia.

Methods

From December 2015 to September 2017, 33 simple renal cyst patients who had surgical indications were enrolled. Under ultrasound guidance, the T10/T11, T11/T12, and T12/L1 paravertebral spaces were identified, and 7-10 mL 0.5% ropivacaine was injected at each segment. Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring. A guidewire was introduced followed by sequential dilation up to 28/30 Fr. The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser, and a pathological examination was performed.

Results

Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients. None of the patients complained of pain during surgery. No serious complications occurred perioperatively. After the surgery, all patients recovered their lower limb muscle strength quickly, got out of bed, resumed oral feeding, and left the hospital within 24 h of admission. The pathologic diagnosis of all cyst walls was a simple renal cyst. The mean follow-up was 35.8 months. At the end of follow-up, the cyst units were reduced in size by more than 50% compared to the preoperative size, and no patient experienced a recurrence.

Conclusion

Multi-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible, safe, and effective for the treatment of simple renal cysts in selected patients.

CEUS Bosniak Classification-Time for Differentiation and Change in Renal Cyst Surveillance

It is time for a change. CEUS is an established method that should be much more actively included in renal cyst monitoring strategies. This review compares the accuracies, strengths, and weaknesses of CEUS, CECT, and MRI in the classification of renal cysts. In order to avoid overstaging by CEUS, a further differentiation of classes IIF, III, and IV is required. A further development in the refinement of the CEUS-Bosniak classification aims to integrate CEUS more closely into the monitoring of renal cysts and to develop new and complex monitoring algorithms.

Features of various methods of surgical treatment of kidney cysts

Background. According to foreign and domestic authors, a kidney cyst is one of the most common urological diseases and accounts for up to 2050%. Aim. To evaluate the results of various methods of surgical treatment of patients with kidney cysts. Materials and methods. An analysis was made of 124 case histories of patients who underwent inpatient treatment for symptomatic kidney cysts at the urology department of the Regional Clinical Hospital for the period 2016 to 2019. Also, an analysis of 50 case histories of patients who were hospitalized with the same diagnosis on the basis of the urological department of the emergency hospital for the same period. Results. Puncture methods of treatment were used only in patients whose cysts radiologically corresponded to categories I and II according to Bosniak. On the basis of the urological department of the emergency hospital, 50 people were operated on in this way, of which 22 (44%) women and 28 (56%) men. The mean age of the patients was 58.25 years. Punctures of cysts with evacuation of contents without sclerotherapy 3 (6%) cases, and puncture of cysts with sclerotherapy with 96% ethyl alcohol 47 (94%) cases. The average age of patients who underwent surgery in the regional hospital was 56.612 years. According to MSCT, cysts of category I according to Bosniak were diagnosed in 96 patients (77.4%), category II in 11 (8.9%), category IIF in 11 patients (8.9%), category III in 6 (4.8%). Laparoscopic excision of the cyst wall was performed in most cases 109 (88%), laparoscopic nephrectomy was performed in 1 case (0.8%), laparoscopic nephrectomy in 10 (8%) cases, retroperitoneoscopic excision of the cyst wall 1 (0.8%), open intervention by lumbotomy access 3 (2.4%), of which nephrectomy was performed in two patients, one patient underwent kidney resection. Conclusion. Surgical treatment of symptomatic kidney cysts was justified and necessary, as evidenced by the relief of symptoms and verification of cysts suspicious in terms of the likelihood of oncological pathology. Puncture methods of drainage and sclerotherapy are less radical, but justified in patients with high surgical risk. Excision of a cyst or resection of a kidney by laparoscopic access is an effective method of treatment that meets modern safety requirements for treatment.

Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts: A retrospective study

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.

A case involving laparoscopic decortication of a large simple renal cyst using conventional monopolar device

Introduction and importance

Simple renal cysts are common in adults, but most of them are asymptomatic. Usually, percutaneous puncture is an initial treatment, but laparoscopic decortication may be effective for recurrent simple renal cyst. Herein, we report a case in which a large symptomatic simple renal cyst was treated with laparoscopic decortication using conventional monopolar device.

Case presentation

A 34-year-old female visited our hospital with chief complaints of back pain and abdominal fullness. Computed tomography showed a right simple renal cyst (diameter: 140 mm). We performed percutaneous drainage with sclerotherapy, but the cyst recurred a month later. Thus, we carried out laparoscopic decortication. We opened the cyst wall via a retroperitoneal approach and trimmed it using monopolar scissors. The operation time was 124 min. The patient's postoperative course was uneventful, and no complications were observed. Following surgery, the patient was asymptomatic.

Clinical discussion

In our case, we performed operation using a conventional monopolar device without sealing devices. It has been reported that the use of sealing devices can make laparoscopic surgery safer and reduce the operation time, but we herein report that laparoscopic decortication with a conventional monopolar device is an effective and safe treatment option for symptomatic simple renal cysts and that more expensive energy sources are not required.

Conclusion

We successfully performed laparoscopic decortication of a large symptomatic simple renal cyst. This operation is minimally invasive and safe.

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Simple renal cyst are common and most cases are asymptomatic, but large simple renal cyst may cause symptoms such as pain.

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As an initial treatment, percutaneous puncture is widely performed, but recurrence rates are high.

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Laparoscopic decortication may be an effective and safe treatment option for large symptomatic simple renal cysts.

Percutaneous versus Laparoscopic treatment for simple renal cysts: a meta-analysis

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.

A Clinical Study of Minilaparoscopy in the Treatment of Cryptorchidism with an Ipsilateral Inguinal Hernia

Introduction: The aim of this study was to investigate the safety and efficacy of performing minilaparoscopy compared with standard laparoscopy in the treatment of cryptorchidism with an ipsilateral inguinal hernia. Materials and Methods: In total, 46 patients with cryptorchidism and an ipsilateral inguinal hernia were admitted to the Urology and Hernia and Abdominal Wall Surgery Departments of Beijing Chaoyang Hospital between October 2009 and July 2019. They were assigned to two groups: Group M and Group S. In Group M, 24 patients underwent herniorrhaphy and orchiopexy using minilaparoscopy, and in Group S, 22 patients underwent herniorrhaphy and orchiopexy using standard laparoscopy. Surgeons chose the procedure at random, and the patients were blinded to the selected procedure. Results: Postoperative painkiller demand (P = .043) and first postoperative day Numerical Rating Scale scores (P = .032) were lower in Group M than Group S, and the average hospital stay was shorter (P = .041) in Group M. Furthermore, 21 of the 24 procedures in Group M were successful, 3 procedures of Group M were converted from mini- to standard laparoscopy, and all 22 procedures in Group S were successful. The Observer Scar Assessment Scale questionnaire results of Group M were significantly higher than for patients in Group S (P = .038). Conclusion: Our findings suggest that treatment of cryptorchidism with ipsilateral inguinal hernia using minilaparoscopy is as safe and effective as standard laparoscopy.

Comparison of aspiration with sclerotherapy and laparoscopic deroofing for the treatment of symptomatic simple renal cysts: a systematic review and meta-analysis

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.

The preliminary experience of methylene blue assisted laparoscopy in the treatment of renal parapelvic cysts

Renal cyst is a common disease in humans and laparoscopic renal cyst decortication is the gold standard for treatment. However, specialized surgical skills are required for the treatment of renal parapelvic cysts. In this study, we describe an improved laparoscopic method for the treatment of renal parapelvic cysts involving the use of continuous infusion of methylene blue. Sixteen patients with renal parapelvic cyst were enrolled in this study. All patients underwent retrograde ureteral catheterization, with continuous perfusion of the renal pelvis using a solution of 0.2% methylene blue and saline, during laparoscopic decortication of the parapelvic cyst. In one patient, the cyst communicated with the renal collection system which was injured, but this was immediately repaired intraoperatively. All operations were successful, and none was converted to open surgery. There were no occurrences of persistent urinary fistula, bleeding, or other complications postoperatively. All patients were followed-up for 3-24 months, and results of postoperative imaging investigations revealed that all of our patients experienced either complete recovery or a greater than 50% decrease in size of the cysts. Our study demonstrates that methylene blue-assisted laparoscopic treatment is a safe, effective and practical method for the treatment of renal parapelvic cysts.

Aspiration-sclerotherapy versus laparoscopic de-roofing in the treatment of renal cysts: which is better?

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.

A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts

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.

A Comparative Study of Percutaneous Aspiration with Sclerotherapy and Laparoscopic Marsupialization for Symptomatic Simple Renal Cysts

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.

Retroperitoneal laparoendoscopic single-site approach for renal cyst decortication - first experience and a review of literature

Laparoendoscopic single-site (LESS) approach has been successfully employed for a number of urologic procedures. The retroperitoneal approach further limits the working space and instrument movement during LESS surgery, but has the advantage of a faster post-operative recovery and lower complications rate. We present our first experience using retroperitoneal LESS approach for a renal cyst decortication in a 40-year-old patient. The operative time was 40 minutes, the blood loss was minimal and we did not encounter significant conflicts between the instruments. The patient was discharged 2 days after the procedure and returned to full normal activity within one week. We consider that the retroperitoneal LESS approach is feasible for upper tract urologic surgery. Pre-bent instruments might further improve surgical gestures and extend the indications for more complex procedures. Nevertheless, the advent of reusable devices is expected to increase the cost-effectiveness of LESS and expand its use.

A rare presentation of simple renal cyst: gastrointestinal obstruction

Simple renal cysts are one of the most common lesions in elderly. These cysts are usually asymptomatic but when the size of these cysts increase, we would see symptoms such as hypertension, hematuria, flank pain or urinary obstruction. In this study, we explore a case of small bowel obstruction that presented with nausea, repeated vomiting that causes hematemesis, and a submucosal obstructive lesion that was seen in Esophagogastroduodenoscopy (EGD). After endoscopic ultrasound (EUS) evaluation, we detected a large simple renal cyst and approved our diagnosis with CT scan. We planned a medical treatment for this patient that consist consuming small size meals, 5 to 6 times a day, and high calorie liquids in small volumes. We conclude that simple renal cyst can be one of the cause of extrinsic intestinal obstruction and EUS is affective for differentiation of intrinsic submucosal lesion from extrinsic compression.

Percutaneous ureteroscopy laser unroofing-a minimally invasive approach for renal cyst treatment

Most simple renal cysts rarely require therapy. When it grows to such a large size, regardless of the presence of symptomatology, surgical intervention is required. In this study, we explored a new approach called percutaneous ureteroscopy laser unroofing for treatment renal cysts and evaluated its safety and efficacy. 71 simple renal cyst patients with surgical indications were enrolled, including 6 patients with a peripelvic cyst and 5 patients coexisting ipsilateral calculi. Under ultrasound guidance, an eighteen-gauge needle was placed inside the cyst cavity, and a guidewire was introduced followed by sequential dilation up to 28 F. The extra-parenchymal portion of cyst wall was dissociated and incised using either a Thulium or Holmium laser, and a pathological examination was performed. Renal calculi were treated simultaneously. For peripelvic cyst patients, one end of a double-J stent was inserted into the cyst cavity to prevent auto-closure. Mean of 11.7 months follow-up, the results showed that the cyst was completely resolved in 53 patients, its size was reduced to less than 50% in 15 patients, and treatment failed in only 3 anterior cyst patients, suggesting that percutaneous ureteroscopy laser unroofing is an effective and less invasive alternative for treatment of renal cysts in selected patients.

Disappearance of Renal Cysts Included in Ice Ball During Cryoablation of Renal-Cell Carcinoma: A Potential Therapy for Symptomatic Renal Cysts?

PURPOSE

To retrospectively evaluate the effect of cryoablation of renal-cell carcinoma on nearby renal cysts with the goal to investigate the potential for an alternative therapy to treat symptomatic renal cysts.

MATERIALS AND METHODS

The study population comprised 46 cysts (mean size, 12 mm; range, 5-43 mm) that were within or near the ice ball during cryoablation in 22 patients. Size change of each cyst was evaluated via enhanced CT or MR imaging before and 1, 3, 6, and 12 months after cryoablation. Forty-one cysts were also followed after 12 months. Variables including positional relationship between the cyst and the ice ball were evaluated via linear regression analysis using generalized estimating equation models to determine which factors affected cyst shrinkage rate at 12 months.

RESULTS

Fifteen, 12, and 19 cysts were completely included in, partially included in, or excluded from the ice ball, respectively. The overall shrinkage rate was 62%, and 57% of cysts (26 of 46) had disappeared at 12 months. Only the relationship between the cyst and the ice ball was significantly (P < .001) associated with cyst shrinkage rate. Cyst disappearance rates at 12 months were 100% (15 of 15), 67% (8 of 12), and 16% (3 of 19) for cysts completely included, partially included, and excluded from the ice ball, respectively. Among the 22 cysts that disappeared at 12 months and continued to be followed, none recurred after 12 months.

CONCLUSIONS

All renal cysts that were completely included in the ice ball disappeared after cryoablation, demonstrating the potential utility of cryoablation as an alternative therapy for symptomatic renal cysts.

Long-term functional results of aspiration and sclerotherapy with ethanol in patients with autosomal dominant polycystic kidney disease: a non-randomized pilot clinical study

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.