Surgical Management of Renal Cystic Disease

Abstract

The kidney is one of the most common sites for cyst in the body (prevalence about 5%). Symptomatic or incidental cyst needs to be characterized further based on Bosniak classification as simple (Bosniak type I & II) or complex (Bosniak type III & IV) cysts with respect to risk of malignancy or other effects on the kidney. The management of simple cysts is entirely for its symptoms or complications (eg, hemorrhage, infection, hydronephrosis, and hypertension). Percutaneous aspiration alone or with sclerotherapy often is the first-line treatment. Surgical decortication generally is reserved for recurrent or very large symptomatic cysts. Laparoscopic surgery is highly efficacious and is associated with high satisfaction rates with minimal morbidity. Retroperitoneal approach is generally preferred, especially in infected or hydatid renal cyst to avoid spillage or contamination of virgin peritoneal cavity. Cyst decortication seems to be an appropriate indication for newer-emerging single-port laparoscopic approaches such as natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, or laparoendoscopic single-site surgery. Where available, robot-assisted surgical management can supplant pure laparoscopic management for complex cysts, hydatid cyst, peripelvic cyst, and autosomal dominant polycystic kidney disease without any outstanding benefits, but with added cost, when robot is used.

Comparison of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts

“…[10] However among rarely seen serious complications as adjacent organ injury, pneumothorax, surgical intervention requiring hematoma, and ureteropelvic stenosis developed in the long-term because of oozing of sclerosing agent into the collecting system have been reported. [6,7] In our series in compliance with the literature data symptomatic and radiological recurrence rates in the aspiration/sclerotherapy group were 5.3, and 36.8%, respectively, while complication (fever) rate was 5.3 percent.…”

“…However recurrence rates up to 90% have been reported in cases where only contents of the cysts were aspirated. [7] Therefore, in addition to aspiration, sclerosing substances were injected into cysts to damage secretory epithelial lining of the cavity with the intention to increase procedural success rates. Firstly, in the year 1981 Bean described the method of aspiration of the simple cyst combined with intracystic injection of sclerosing agent (95% ethanol) with success rates increasing up to 97 percent.…”

“…[8] In advanced years, with the same objective many scelorising agents as glucose, sodium marfuate, lipidol, phenol, tetracycline, minocycline-HCl, bismuth phosphate, urea colo-hydrolactate, polydocanol, pantopac, acetic acid, povidone-iodine, ethanolamine oleate, OK-432, and n-buthyl cyanoacrilate have been used. [2,4,7] As demonstrated in the literature none of the sclerosing agents used is more advantageous than others. Besides, recurrence rates ranging between 3-100% have been reported when aspiration/sclerotherapy was used in the management of simple renal cysts.…”

Intraperitoneal marsupialization of a giant para-pelvic renal cyst: A case report

“…7 Recently, percutaneous aspiration of renal cysts along with injection of sclerosing agents (such as alcohol) have been explored as a potential treatment option. 10 This approach of percutaneous management can be effective, especially if the cyst is relatively small and para-pelvic in location; however, if more than 200 mL of the original volume persists after this procedure, then surgery becomes necessary.…”

“…6 Surgical treatment is indicated only if the cyst becomes symptomatic or if it is suspicious for malignancy. 7 Numerous surgical approaches to manage renal cysts have been described, including open, laparoscopic 8 and retroperitoneoscopic 9 procedures. We report the intraperitoneal marsupialization of a giant parapelvic renal cyst -a rarely performed procedure.…”