Ureteroscopic management of asymptomatic and symptomatic simple parapelvic renal cysts

Abstract

BackgroundTo investigate feasibility and safety of treating simple parapelvic renal cysts using flexible ureteroscopy with the Holmium laser.MethodsBetween February 2010 and July 2013, a total of 21 patients, aging from 29 to 71 (49.00 ± 13.23), were diagnosed with parapelvic renal cysts by ultrasonography in combination with contrast-enhanced computer tomography (CT) and intravenous urography (IVU) in the Department of Urology Surgery, People’s Hospital of the Zhejiang province. Fifteen patients were asymptomatic and 6 patients were symptomatic with flank pain. All patients underwent drainage of the cysts using flexible ureteroscopy with Holmium laser. Patients were followed up 1, 3 and 12 months after the operation.ResultsThe intervention was successful in 20 patients and failed in 1 patient who, subsequently successfully underwent a laparoscopic cyst removal. There were no intra-operative and post-operative complications reported. The mean operation time was 27 min (range: 15 to 45 min). The mean hospital stay was 2.6 days (range: 1 to 5 days). Twenty patients were followed up until 15 months after surgery. After such ureteroscopic management, there were no renal cysts detected in 7 patients (35 %) and a reduction in size of the renal cysts was found in 13 patients (65 %). Flank pain subsided in all 6 (100 %) previously symptomatic patients.ConclusionsFlexible ureteroscopy with the Holmium laser may be a feasible and effective treatment option in selected patients with simple parapelvic renal cysts. Further prospective randomized studies that compare the procedure to laparoscopic treatments are needed.

Different Successful Management Strategies for Obstructing Renal Parapelvic Cysts

“…Antegrade percutaneous nephroscopic ablation, with cyst wall fulguratation using a resectoscope with a rollerball electrode, has also been demonstrated to be safe and effective [2]. More recently, retrograde management with flexible ureteroscopy and incision and drainage of the renal cyst wall using a holmium laser has been demonstrated to be safe and effective [5]. Ureteroscopy is the least invasive option following simple aspiration; however, it is reserved for smaller cysts and is contraindicated in the presence of ureteric stricture.…”

Retrograde Intrarenal Surgery for Symptomatic Renal Sinus Cysts: Long-Term Results and Literature Review

“…In another series with a mean follow-up of 39 months (range 10–72), the radiologic disappearance of the cyst was achieved in 22 (78.6%) of the 28 treated patients; the cyst size reduced to less than half of the previous size in 4 (14.3%) and recurred in 1 [18]. Mao et al [12] reported about 21 patients with RSCs greater than 3 cm treated by RIR-HoLI; however, only 6 were symptomatic. At 15 months follow-up, there was one recurrence requiring laparoscopic treatment; all 6 symptomatic patients became and remained ­asymptomatic.…”

“…Most importantly, it is highly effective but with a lower risk of complications. In particular, the excellent vision prevents the risk of urinary fistula, which may follow laparoscopic unroofing due to incapacity to distinguish the cyst from the renal collecting system [12]. Finally, laparoscopic unroofing is more expensive and requires more advanced surgical skills than RIR-HoLI [9, 11, 24, 25]; however, it remains appropriate in case of ureteral stenosis or cysts suspicious for malignancy [9].…”

“…Retrograde intrarenal laser incision (RIR-HoLI) has been proposed as an effective and minimally invasive treatment for RSCs [9-12]. In this study, we report our long-term experience with such treatment in the management of symptomatic RSCs.…”

Preliminary study on the differentiation between parapelvic cyst and hydronephrosis with non-calculous using only pre-contrast dual-energy spectral CT scans

“…The parapelvic cyst is a rare disease in the clinic with a detection rate in autopsy of about 1.25-1.5%. 1 It is believed to originate from the secondary lymphatic obstruction, 2 and most of the patients were occasionally found without any symptoms. 3 However, when the cyst is large enough, it may lead to hypertension, haematuria, hydronephrosis or secondary infection, and even acute renal failure.…”