Percutaneous Drainage of Simple Cysts of the Kidney: A New Method

Abstract

Objective: The experience of our department on the treatment of solitary simple kidney cysts with continuous percutaneous drainage for 24 h and instillation of pure alcohol as a sclerotic agent is reported. The results are compared with those of previous years when the treatment consisted of percutaneous drainage and injection of pure alcohol. Patients and Methods: During the period 1992–2001, 252 patients (136 male, 116 female; aged 22–74 years) were treated at our department, and all had a solitary kidney cyst. They were treated by percutaneous drainage and then injection of pure alcohol for 20 min via a nephrostomy tube (which remained in position for 24 h). The mean follow-up period was 5 years. This cohort of patients was compared to another one of 238 patients who were treated with a previous method (126 male, 124 female; aged 28–79 years, mean 59 years). Results: In 71% of the patients the symptoms and the cyst both disappeared, in 22% there was no significant recurrence (i.e. cyst diameter <5 cm), and the remaining 7% presented significant recurrence (i.e. cyst diameter >5 cm). Most of the latter cases were treated again using the same method. Of the 73 patients with impaired kidney function, in 61 (83%) this appeared to have improved as a result of our treatment. Of the 61 patients with hypertension, in 29 (47%) this appeared to have improved. There was only 1 case with complications, which presented purulence of the cyst that required open surgery. In previous case series, which were treated with percutaneous drainage and injection of pure alcohol just after the puncture of the cyst – without continuous drainage of the cyst for 24 h – only 10% of the patients had no recurrence, 30% had no significant recurrence (volume of the cyst <20% of the pre-operative volume), and 60% of the patients had significant recurrence (volume of the cyst >20% of the pre-operative volume). Conclusions: Percutaneous drainage of solitary kidney cysts for 24 h followed by injection of pure alcohol, as a sclerotic agent, is an effective therapeutic method with only a few complications. It was therefore considered being the proffered method for the treatment of solitary kidney cysts.

Treatment of symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy

“…There was complete resolution of the cyst in 84% of them. Similar results were reported, at 71–97%, by other authors who used single or multiple injections with or without 24 h continuous cyst drainage before or after ablation [2,4,8,9,11,14]. Early reports showed a high cyst resolution rate after aspiration and one sclerotherapy injection with alcohol [15].…”

“…We repeated the procedure immediately after draining the alcohol in cysts of moderate size, but repeated it every 24 h two or three times after an initial 24‐h of drainage in patients with large cysts. The efficacy of continuous drainage for 24 h before injection of alcohol was also reported by Touloupidis et al [4].…”

“…Similarly, Veroux et al [12] reported cure of a donor's hypertension after live‐donor transplantation using a kidney with a large cyst. Also, Touloupidis et al [4] found that of the 61 patients with hypertension, 29 (47%) appeared to have their hypertension improved after sclerotherapy of simple renal cysts.…”

“…Aspiration without sclerotherapy of simple renal cysts is minimally invasive but has a high recurrence rate that may be >90%[1,8]. Aspiration followed by sclerotherapy has been reported to have better success rates than simple aspiration, with a much lower recurrence rate [2,4,8–11]. In the present series we report our experience of using 95% ethanol as sclerosing agent for treating symptomatic simple renal cysts.…”

A New Technique for Simple Renal Cyst: Cystoretroperitoneal Shunt

“…In our study, six hypertensive patients (46.1%) benefited from treatment with normalization of blood pressure. Similarly, Touloupidis et al found that, of 61 patients with hypertension, 29 had improved blood pressures after sclerotherapy of simple renal cysts [6]. …”