1
|
Tseng WH, Hsieh CC, Huang SK, Liu CL, Lee KH, Hsieh KL, Chen ZH, Chiu AW, Li CF, Shiue YL. Advantages of retrograde intrarenal incision versus laparoscopic surgery in management of pararenal cysts: a single-center experience. Int Urol Nephrol 2024; 56:1307-1313. [PMID: 38044410 DOI: 10.1007/s11255-023-03881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Renal cysts are typically a benign condition, and parapelvic cysts are a type of renal cyst that occur adjacent to the renal pelvis or renal sinus. Parapelvic cysts can increase the risk for injury to adjacent organs or urine leakage during laparoscopic surgery. Flexible ureteroscopes with laser assistance were used to make internal incisions in cysts. Perioperative outcomes of this method were compared with those of laparoscopic surgery. METHODS Eight-three patients, who underwent surgical treatment for renal cysts at the authors' medical center between January 2019 and June 2022, were evaluated. Two patients were excluded because they originally opted for RIRS but subsequently converted to laparoscopic surgery. Patients were divided into 2 groups based on surgery type: laparoscopic; and RIRS for internal incision. Outcomes in both groups were analyzed. RESULTS Of the 81 patients analyzed, 60 [74% (group 1)] underwent laparoscopic surgery and 21 [26% (group 2)] underwent RIRS for internal incision. The median operative durations for groups 1 and 2 were 87 and 56 min, respectively (p < 0.001). Relative to RIRS, laparoscopic surgery resulted in greater postoperative painkiller use (laparoscopic surgery versus [vs.] RIRS, 43% vs. 19%; p = 0.047). The median length of hospital stay was 2 and 1 days, respectively (p < 0.001). CONCLUSIONS RIRS demonstrated several advantages over laparoscopic surgery for the internal incision of parapelvic cysts, including shorter operative duration, shorter hospital stay, and less postoperative pain control. These findings may guide the selection of appropriate surgical approaches for patients with renal cysts.
Collapse
Affiliation(s)
- Wen-Hsin Tseng
- Institute of Biomedical Science, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Chia-Chih Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC.
| | - Steven K Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Chien-Liang Liu
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
- Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Kun-Lin Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Zhi-Hao Chen
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan, ROC
| | - Allen W Chiu
- Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chien-Feng Li
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Science, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Institute of Precision Medicine, College of Medicine, National Sun Yat-Sen University, No. 70, Lienhai Rd., Kaohsiung, 80424, Taiwan, ROC.
| |
Collapse
|
2
|
Lucocq J, Morgan L, Rathod K, Szewczyk-Bieda M, Nabi G. Validation of the updated Bosniak classification (2019) in pathologically confirmed CT-categorised cysts. Scott Med J 2024; 69:18-23. [PMID: 38111318 DOI: 10.1177/00369330231221235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
INTRODUCTION The updated Bosniak classification in 2019 (v2019) addresses vague imaging terms and revises the criteria with the intent to categorise a higher proportion of cysts in lower-risk groups and reduce benign cyst resections. The aim of the present study was to compare the diagnostic accuracy and inter-observer agreement rate of the original (v2005) and updated classifications (v2019). METHOD Resected/biopsied cysts were categorised according to Bosniak classifications (v2005 and v2019) and the diagnostic accuracy was assessed with reference to histopathological analysis. The inter-observer agreement of v2005 and v2019 was determined. RESULTS The malignancy rate of the cohort was 83.6% (51/61). Using v2019, a higher proportion of malignant cysts were categorised as Bosniak ≥ III (88.2% vs 84.3%) and a significantly higher percentage were categorised as Bosniak IV (68.9% vs 47.1%; p = 0.049) in comparison to v2005. v2019 would have resulted in less benign cyst resections (13.5% vs 15.7%). Calcified versus non-calcified cysts had lower rates of malignancy (57.1% vs 91.5%; RR,0.62; p = 0.002). The inter-observer agreement of v2005 was higher than that of v2019 (kappa, 0.70 vs kappa, 0.43). DISCUSSION The updated classification improves the categorisation of malignant cysts and reduces benign cyst resection. The low inter-observer agreement remains a challenge to the updated classification system.
Collapse
Affiliation(s)
- James Lucocq
- Department of General Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Leo Morgan
- Department of General Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UK
| | - Ketan Rathod
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | | | - Ghulam Nabi
- Department of Urology, Ninewells Hospital, Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Dundee, UK
| |
Collapse
|
3
|
Malkhasyan VA, Makhmudov TB, Gilfanov YS, Semenyakin IV, Sukhikh SO, Pushkar DY. [Effect of a simple kidney cyst on renal function]. Urologiia 2023:75-81. [PMID: 37850285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Renal cysts are a common disease that occurs at a rate of 7-10%. Currently there are no clinical recommendations for the treatment of patients with simple renal cysts. In the current literature there is some evidence that a simple renal cyst has negative effects on renal function. Decreased renal function occurs due to partial atrophy and loss of the renal parenchyma (in the "crater" area at the base of the cyst) caused by compression. Therefore, the efforts to analyze the effect of simple kidney cysts on kidney function and identify the characteristics of the cyst that affect renal function to determine the indications for surgical treatment remains a substantial task. The aim of the study was to analyze the effect of simple renal cysts on renal function, to investigate the relationship between cyst size, atrophied parenchyma volume, and renal function, and to determine indications for surgical treatment of simple renal cysts. MATERIALS AND METHODS We conducted a prospective cohort study. The study included 109 patients with simple renal cysts. Patients with a solitary cyst of the right or left renal kidney, grade I-II according to Bosniak classification, were included in the study. The estimated glomerular filtration rate (eGFR) of the patients was calculated using various formulas. A contrast CT scan of the urinary tract was also performed to determine the maximum size of the cyst, calculate the volume of the renal parenchyma, and the volume of the lost (atrophied) parenchyma. Patients underwent renal scintigraphy with calculation of total GFR and split renal function. We analyzed the symmetry of the function of both kidneys by comparing the GFR of the affected and healthy kidneys, analyzed the relationship between the presence of a kidney cyst and a decrease in GFR, between the maximum size of a renal cyst and a decrease in its function compared with that of a healthy kidney. We also analyzed the correspondence of total GFR values obtained in renal scintigraphy and GFR values calculated according to the formulas. RESULTS Data from 109 patients were available for analysis; the mean blood creatinine was 87.4 mol/L. The median maximum cyst size was 80 mm. The median baseline volume of the affected kidney parenchyma was 174 ml, the median volume of the lost parenchyma was 49 ml, and the median proportion of the lost parenchyma was 28%. The median total GFR was 77.07 ml/min. The median GFR of the healthy kidney was 45.49 mL/min, and the median GFR of the kidney affected by the cyst was 34.46 mL/min. The median difference in GFR of the healthy and affected kidney units was 11 mL/min and was statistically significant. Comparison of the eGFR values obtained by the formulas with the reference values of GFR obtained by scintigraphy showed that the Cockcroft-Gault formula with standardization on the body surface area calculated closest eGFR values to the reference ones. Correlation analysis revealed a statistically significant association between the proportion of lost parenchyma volume and the maximum cyst size: =0.37 with 95% CI [0.20; 0.52] (p-value = 0). A multivariate logistic regression model revealed that a statistically significant factor influencing the probability of a significant decrease in GFR was the percent of lost renal parenchyma volume (OR=1,13; =0). CONCLUSIONS Our study showed that growth of renal cysts associated with renal parenchyma atrophy and decrease of GFR of the affected kidney. An increase in the volume of atrophied parenchyma leads to the decrease in GFR of the affected kidney. The obtained data suggest that performing dynamic renal scintigraphy to assess the decrease in affected renal function and determine the indications for surgical treatment of renal cysts is a reasonable recommendation. According to the results of the study, the loss of 20% of the renal parenchyma can be considered an indication for renal scintigraphy. The Cockcroft-Gault formula with standardization on the body surface area allows to calculate closest GFR values to those obtained by scintigraphy and, therefore, can be recommended as the optimal formula for calculating eGFR in daily clinical practice.
Collapse
Affiliation(s)
- V A Malkhasyan
- S.I.Spasokukotsky City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
- A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- MDDC SberMEDI LLC, Moscow, Russia
- Medsi group JSC, Moscow, Russia
| | - T B Makhmudov
- S.I.Spasokukotsky City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
- A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- MDDC SberMEDI LLC, Moscow, Russia
- Medsi group JSC, Moscow, Russia
| | - Yu Sh Gilfanov
- S.I.Spasokukotsky City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
- A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- MDDC SberMEDI LLC, Moscow, Russia
- Medsi group JSC, Moscow, Russia
| | - I V Semenyakin
- S.I.Spasokukotsky City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
- A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- MDDC SberMEDI LLC, Moscow, Russia
- Medsi group JSC, Moscow, Russia
| | - S O Sukhikh
- S.I.Spasokukotsky City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
- A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- MDDC SberMEDI LLC, Moscow, Russia
- Medsi group JSC, Moscow, Russia
| | - D Y Pushkar
- S.I.Spasokukotsky City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
- A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- MDDC SberMEDI LLC, Moscow, Russia
- Medsi group JSC, Moscow, Russia
| |
Collapse
|
4
|
Iwata T, Hayashi I, Gabata Y, Hongo F. Intraoperative ultrasonography in laparoscopic off-clamp partial nephrectomy for renal cell carcinoma adjacent to multiple renal cysts: a case report. J Med Ultrason (2001) 2023; 50:453-455. [PMID: 37119449 DOI: 10.1007/s10396-023-01307-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Tsuyoshi Iwata
- Department of Urology, Kyoto Min-Iren Chuo Hospital, 2-1 Uzumasa-Tsuchimoto-cho, Kyoto City, 616-8147, Japan.
| | - Issei Hayashi
- Department of Urology, Kyoto Min-Iren Chuo Hospital, 2-1 Uzumasa-Tsuchimoto-cho, Kyoto City, 616-8147, Japan
| | - Yusuke Gabata
- Department of Urology, Kyoto Min-Iren Chuo Hospital, 2-1 Uzumasa-Tsuchimoto-cho, Kyoto City, 616-8147, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kyoto City, 602-8566, Japan
| |
Collapse
|
5
|
Lee RA, Uzzo RG, Anaokar J, Thomas A, Wei S, Ristau BT, McIntosh A, Lee M, Chen DYT, Greenberg RE, Viterbo R, Smaldone MC, Correa A, Schober J, Ginsburg K, Bukavina L, Magee D, Uzzo N, Parkansky P, Ruth K, Kutikov A. Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses. J Urol 2023; 209:686-693. [PMID: 36630588 DOI: 10.1097/ju.0000000000003158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE We evaluated oncologic risks in a large cohort of patients with radiographic cystic renal masses who underwent active surveillance or intervention. MATERIALS AND METHODS A single-institutional database of 4,340 kidney lesions managed with either active surveillance or intervention between 2000-2020 was queried for radiographically cystic renal masses. Association of radiographic tumor characteristics and high-grade pathology was evaluated. RESULTS We identified 387 radiographically confirmed cystic lesions in 367 patients. Of these, 247 were resected (n=240) or ablated (n=7; n=247, 203 immediate vs 44 delayed intervention). Pathologically, 23% (n=56) demonstrated high-grade pathology. Cystic features were explicitly described by pathology in only 18% (n=33) of all lesions and in 7% (n=4) of high-grade lesions. Of the intervention cohort, African American race, male gender, and Bosniak score were associated with high-grade pathology (P < .05). On active surveillance (n=184), Bosniak IV lesions demonstrated faster growth rates than IIF and III lesions (2.7 vs 0.6 and 0.5 mm/y, P ≤ .001); however, growth rates were not associated with high-grade pathology (P = .5). No difference in cancer-specific survival was identified when comparing intervention vs active surveillance at 5 years (99% vs 100%, P = .2). No difference in recurrence was observed between immediate intervention vs delayed intervention (P > .9). CONCLUSIONS A disconnect between "cystic" designation on imaging and pathology exists for renal lesions. Over 80% of radiographic Bosniak cystic lesions are not described as "cystic" on pathology reports. More than 1 in 5 resected cystic renal lesions demonstrated high-grade disease. Despite this finding, judiciously managed active surveillance ± delayed intervention is a safe and effective management option for most radiographic cystic renal masses.
Collapse
Affiliation(s)
- Randall A Lee
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jordan Anaokar
- Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Ashanth Thomas
- Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shuanzeng Wei
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Benjamin T Ristau
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Andrew McIntosh
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Matthew Lee
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - David Y T Chen
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard E Greenberg
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rosalia Viterbo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Andres Correa
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared Schober
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Kevin Ginsburg
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Laura Bukavina
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Diana Magee
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nicole Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Phyllis Parkansky
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Karen Ruth
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| |
Collapse
|
6
|
Xu L, Wang L, Tian X, Gai Y, Shang N. Spontaneously ruptured multilocular cystic nephroma in an infant. J Clin Ultrasound 2023; 51:107-109. [PMID: 35862291 DOI: 10.1002/jcu.23267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
We present the case of a 10-month-old girl with spontaneously ruptured cystic nephroma with a 1-week-old abdominal mass and a 1-day history of marked abdominal distension. The tumor presented as gourd-shaped, cystic solid mass in the right kidney with fluid collection. The tumor was successfully removed by urgent surgery. The girl remained in good condition throughout six-month follow-up after.
Collapse
Affiliation(s)
- Ling Xu
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Limin Wang
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiangying Tian
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yuanyuan Gai
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ning Shang
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| |
Collapse
|
7
|
Simonov PA, Firsov MA, Laletin DI, Alekseeva EA, Junker AI. [Features of surgical treatment of renal cysts depending on the risk of malignancy]. Urologiia 2022:23-26. [PMID: 36098585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND According to national and foreign publications, renal cyst is one of the most common urological diseases with a prevalence up to 20-50%. AIM To determine the results of surgical treatment of patients with renal cysts, depending on the risk of malignancy. MATERIALS AND METHODS The analysis of 124 patients with symptomatic renal cysts who were treated in the Department of Urology of Regional Clinical Hospital was carried out. All patients underwent a comprehensive clinical and instrumental evaluation, including contrast-enhanced CT scan of the kidneys. To assess the risk of harboring malignant tumor, the classification of renal cysts of Bosniak (2019) was used. RESULTS The average age of patients was 56.6+/-12 years. According to CT, Bosniak I, II, IIF and III cysts were diagnosed in 96 (77.4%), 11 (8.9%), 11 (8.9%) and 6 (4.8%) patients, respectively. The morphologic study revealed renal cell cancer in 8 patients (6.4%), four of whom had Bosniak III cysts and other four had Bosniak IIF cysts. DISCUSSION The prediction of the harboring of malignancy is a fundamental criterion for selection of patients with renal cysts for surgical treatment. CONCLUSION Surgical treatment of symptomatic renal cysts is a justified treatment method, and in patients with Bosniak class II or higher cysts, it is necessary to exclude the malignant lesion. Based on our data, category IIF and III cysts have a high risk of harboring malignant cells, which is 36.4% and 66.7%, respectively. In our opinion, laparoscopic partial nephrectomy is the most rational treatment method in these categories.
Collapse
Affiliation(s)
- P A Simonov
- GBUZ Regional Clinical Hospital, Krasnoyarsk, Russia
- Department of Urology, Andrology and Sexology, FGBOU VO Krasnoyarsk State Medical University. Prof. V.F. Voino-Yasenetsky Ministry of Health of Russia Krasnoyarsk, Russia
| | - M A Firsov
- GBUZ Regional Clinical Hospital, Krasnoyarsk, Russia
- Department of Urology, Andrology and Sexology, FGBOU VO Krasnoyarsk State Medical University. Prof. V.F. Voino-Yasenetsky Ministry of Health of Russia Krasnoyarsk, Russia
| | - D I Laletin
- GBUZ Regional Clinical Hospital, Krasnoyarsk, Russia
- Department of Urology, Andrology and Sexology, FGBOU VO Krasnoyarsk State Medical University. Prof. V.F. Voino-Yasenetsky Ministry of Health of Russia Krasnoyarsk, Russia
| | - E A Alekseeva
- GBUZ Regional Clinical Hospital, Krasnoyarsk, Russia
- Department of Urology, Andrology and Sexology, FGBOU VO Krasnoyarsk State Medical University. Prof. V.F. Voino-Yasenetsky Ministry of Health of Russia Krasnoyarsk, Russia
| | - A I Junker
- GBUZ Regional Clinical Hospital, Krasnoyarsk, Russia
- Department of Urology, Andrology and Sexology, FGBOU VO Krasnoyarsk State Medical University. Prof. V.F. Voino-Yasenetsky Ministry of Health of Russia Krasnoyarsk, Russia
| |
Collapse
|
8
|
Dekerle B, Fabres V, Benchekroun G, Manassero M. Long-term follow-up of a juvenile simple renal cyst in a dog treated by laparoscopic deroofing, fulguration, and omentalization. J Am Vet Med Assoc 2022; 260:1-5. [PMID: 35263277 DOI: 10.2460/javma.21.06.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 10-month-old male crossbred dog presented with a 4-week history of polyuria and polydipsia and a 6-month history of vomiting. CLINICAL FINDINGS Clinical examination revealed abdominal pain and right-sided nephromegaly. Biochemistry was within normal limits. Diagnostic imaging showed a well-defined, unilateral renal mass containing anechoic fluid consistent with a simple renal cyst (SRC). TREATMENT AND OUTCOME The cyst was drained under ultrasonographic guidance but recurred 3 months later, concomitant with recurrence of the previously reported clinical signs. The cyst was then deroofed, fulgurated, and omentalized under laparoscopy by use of a 3-port technique. The resected cystic wall was histopathologically consistent with an SRC, presumptively congenital. The dog showed a good recovery with resolution of clinical signs. Renal function was normal at last follow-up, conducted 2 years postoperatively, without evidence of recurrent disease. CLINICAL RELEVANCE To our knowledge, this was the first report of a symptomatic juvenile SRC of presumptively congenital origin in a dog treated successfully by laparoscopic deroofing, fulguration, and omentalization. The polyuria, polydipsia, chronic vomiting, and abdominal pain may all have been related to space-occupying effects of the cyst, as these symptoms resolved post-treatment. Results of long-term follow-up advocate for this durable cure of SRC by use of laparoscopic procedures, especially when compared to simple drainage of the cyst, as the latter initially failed in the present case.
Collapse
|
9
|
Martov AG, Yagudaev DD, Ergakov DV, Baikov NA, Andronov AS, Dutov SV, Martov AA, Abdullaev DA. [Endoscopic marsupialization of parapelvic renal cysts]. Urologiia 2022:61-66. [PMID: 35274861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Parapelvic renal cysts are very common. Indications for surgical treatment are upper urine tract obstruction, pain and recurrent gross hematuria. AIM To analyze the efficiency and safety of endoscopic transurethral and percutaneous laser marsupialization of parapelvic renal cysts. MATERIALS AND METHODS A total of 9 patients were undergone to transurethral intrarenal marsupialization of parapelvic renal cysts from March 2016 to February 2021 (4 men, 5 women, aged 42-78 years). Another 2 patients (2 men, aged 46 and 52 years) were treated by percutaneous approach. The average size of the cyst according to contrast-enhanced multi-slice computed tomography (MSCT) was 3.1+/-1.8 cm. In two cases, papillary tumor of the pelvis was suspected. The anteroposterior diameter of the pelvis was 2.6+/-1.3 cm; 9 patients had pain in the loin area, while in 7 patients recurrent gross hematuria was also an indication for surgical treatment. For marsupialization, a holmium (Ho:YAG) laser Auriga XL (Boston Scientific, USA) was used in 4 patients, and in other cases (n=7) a procedure was performed using a thulium fiber laser (Tm Fiber) Fiberlase U1 (IRE-Polus, Russia). In 3 patients, to clarify the site of incision of the cyst, intraoperative ultrasound was used. In all cases, after draining the cyst, an internal stent was placed inside the cyst for a period of 4-6 weeks. RESULTS The duration of transurethral surgery was 26+/-11 minutes, while percutaneous marsupialization of the cyst, which was performed in combination with percutaneous nephrolithotomy, took 10 and 18 minutes, respectively. The average catheterization time was 12+/-8 hours. Nephrostomy tube was removed on the 2nd day. The length of stay was 4+/-2 days. Febrile fever was noted in 1 patient (9%), which required a change in antibiotic therapy. During ultrasound control at discharge, the dilatation of the collecting system was not detected in any cases, while the residual cavity was found in 2 patients (18%). Follow-up contrast-enhanced MSCT and ultrasound within 3-30 months in all patients (n=11) showed no dilatation of the collecting system. In 1 (9%) patient, the residual cavity was preserved with a decrease in size to 1.2 cm without signs of upper urinary tract obstruction; the initial diameter of the cyst in this patient was 4.9 cm. There was no recurrence of gross hematuria. CONCLUSIONS In our opinion, transurethral and percutaneous laser marsupialization of parapelvic renal cysts is an effective and safe method that allows definitive treatment for cysts up to 4 cm in size. If the cyst is larger than 4 cm, endoscopic removal should be balanced with the possibility of preserving the residual cavity. The most common complication of endoscopic treatment of intrarenal cysts is acute pyelonephritis with a rate of 9%.
Collapse
Affiliation(s)
- A G Martov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - D D Yagudaev
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - D V Ergakov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - N A Baikov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - A S Andronov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - S V Dutov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - A A Martov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| | - D A Abdullaev
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
| |
Collapse
|
10
|
Zhang Z, Chen D, Deng L, Li W, Wang X, Zhang Y, Liekui F, Feloney MP, Zhang Y. Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature. J Xray Sci Technol 2021; 29:185-196. [PMID: 33459688 DOI: 10.3233/xst-200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. PATIENTS AND METHODS Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. RESULTS In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 -44 ml/min). CONCLUSIONS For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.
Collapse
Affiliation(s)
- Zejian Zhang
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Dong Chen
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Ling Deng
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Wei Li
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Xisheng Wang
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Yixiang Zhang
- Department of Urology, Shenzhen People's Hospital,The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province,China
| | - Fang Liekui
- Department of Urology, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen third people's hospital, Shenzhen, Guangdong Province, China
| | - Michael P Feloney
- Department of Urology, Creighton University School of Medicine, Omaha, NE, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
11
|
Wang X, Zhang Z, Zhu X, Cheng W, Fang J, Cai Y, Li W, Thakker PU, Zhang Y. A rare case of a cystic renal mass with heterotopic ossification and a mini literature review. J Xray Sci Technol 2021; 29:541-549. [PMID: 33749630 DOI: 10.3233/xst-210863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION It is a challenge to make accurate pre-surgical diagnosis for renal tumors. This study is to report the findings, management, and outcome of one rare case of ossification in a cystic renal mass. We present and discuss the pathological characteristics, radiologic features, and treatment alternatives of the patient. PATIENTS AND METHODS A 38 years old female patient had intermittent epigastric pain and microscopic hematuria for two months. Computerized tomography (CT) scan and Magnetic Resonance imaging (MRI) showed a mass with rough edge and dense calcification in the upper pole of the right kidney and normal left kidney. Pre-operative diagnosis is cystic nephroma or cystic renal mass (Bosniak III type, Bosniak renal cyst classification). GFR was within normal limits for age and no other significant laboratory aberrations were noted. Patient underwent a right retroperitoneal laparoscopic partial nephrectomy (margin status was negative). A mini literature review was performed to highlight the principals of diagnosis and treatment of cystic renal mass with heterotopic ossification. RESULTS The entire renal mass was successfully removed from upper pole of the right kidney by laparoscopic nephron sparing surgery. The size of renal mass is 38×35×30 mm3 with thick and hard capsular wall. The cystic cavity contains yellow lipid-like substances without stone. Histological examination revealed renal cyst in which the cyst wall reveals fibrosis and no obvious lining epithelium. The additional unique feature includes the presence of dense calcification and ossification in the renal mass. Localization tissue of yellow bone marrow was detected. No complications occurred in 9 months after surgery during follow-up. CONCLUSIONS Cystic renal mass with heterotopic ossification is a rare case of non-malignant renal tumor. Whether surgery is needed depends to whether patients have symptoms. For symptom renal tumors, laparoscopic nephron sparing surgical procedure is recommended. Furthermore, complete surgical resection of the lesion is needed when the mass is suspected to be malignant. An accurate histologic diagnosis is key in its diagnosis.
Collapse
Affiliation(s)
- Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Xia Zhu
- Department of Medical Examination, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Wende Cheng
- Pathology Department, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Jiqing Fang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Yuefeng Cai
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Wei Li
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Parth Udayan Thakker
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Waldram MM, Thomas AG, Yu Y, Holscher CM, Nguyen AQ, Halpern SE, Ottman S, Muzaale AD, Henderson ML, Lentine KL, Al Ammary F, Brennan DC, Garonzik-Wang JM, Segev DL, Massie AB. Long-term renal function in living kidney donors with simple renal cysts: A retrospective cohort study. Clin Transplant 2020; 34:e13905. [PMID: 32399996 PMCID: PMC8720490 DOI: 10.1111/ctr.13905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 01/25/2023]
Abstract
Simple (Bosniak I) renal cysts are considered acceptable in living kidney donor selection in terms of cancer risk. However, they tend to increase in number and size over time and might compromise renal function in donors. To clarify their implications for long-term renal function, we characterized the prevalence of renal cysts in 454 individuals who donated at our center from 2000 to 2007. We estimated the association between the presence of cysts in the kidney remaining after nephrectomy (ie, retained cysts) and postdonation eGFR trajectory using mixed-effects linear regression. Donors with retained cysts (N = 86) were older (P < .001) and had slightly lower predonation eGFR (median 94 vs 98 mL/min/1.73 m2 , P < .01) than those without cysts. Over a median 7.8 years, donors with retained cysts had lower baseline eGFR (-8.7 -5.6 -2.3 mL/min/1.73 m2 , P < .01) but similar yearly change in eGFR (-0.4 0.02 0.4 mL/min/1.73 m2 , P = .2) compared to those without retained cysts. Adjusting for predonation characteristics, there was no difference in baseline eGFR (P = .6) or yearly change in eGFR (P > .9). There continued to be no evidence of an association when we considered retained cyst(s) ≥10 mm or multiple retained cysts (all P > .05). These findings reaffirm current practices of accepting candidates with simple renal cysts for donor nephrectomy.
Collapse
Affiliation(s)
- Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yifan Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Courtenay M. Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anh Q. Nguyen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samantha E. Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shane Ottman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
14
|
Park J, Moon C, Lee M, Lee HB, Jeong SM. Surgical fenestration combined with omentalization for the treatment of renal cysts in 2 dogs. Can Vet J 2019; 60:1104-1110. [PMID: 31597997 PMCID: PMC6741834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Two cases of surgical fenestration combined with omentalization for canine renal cysts using laparotomy and laparoscopy are described. After surgery, the cystic lesions gradually diminished in size, and a complete regression was confirmed in Case 2 by ultrasonography. The dogs maintained good condition without clinical signs of renal compromise for 14 months (Case 1) and 24 months (Case 2). Omentalization is a simple and effective procedure for canine renal cysts that conserves the remaining parenchyma and can be performed by a laparoscopic approach.
Collapse
Affiliation(s)
- Jiyoung Park
- Ulsan Smart Animal Medical Center, Ulsan, Republic of Korea (Park); College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea (Moon, M. Lee, H-B. Lee, Jeong)
| | - Changhwan Moon
- Ulsan Smart Animal Medical Center, Ulsan, Republic of Korea (Park); College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea (Moon, M. Lee, H-B. Lee, Jeong)
| | - Mokhyeon Lee
- Ulsan Smart Animal Medical Center, Ulsan, Republic of Korea (Park); College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea (Moon, M. Lee, H-B. Lee, Jeong)
| | - Hae-Beom Lee
- Ulsan Smart Animal Medical Center, Ulsan, Republic of Korea (Park); College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea (Moon, M. Lee, H-B. Lee, Jeong)
| | - Seong Mok Jeong
- Ulsan Smart Animal Medical Center, Ulsan, Republic of Korea (Park); College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea (Moon, M. Lee, H-B. Lee, Jeong)
| |
Collapse
|
15
|
Serrano Á, Sánchez M, Ciappara M, López E, Laso S, Jerez T, Barrera J, Cortés JA, González-Peramato P, Blazquez J, Moreno J. [Laparoscopic renal cyst excision: Large simple renal cyst treatment with renal cell carcinoma cells in its wall. Histogenetic considerations and bibliographic review.]. ARCH ESP UROL 2019; 72:422-428. [PMID: 31070139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The incidence of simple renal cysts is very high, especially in elderly people. However, malignant transformation of a simple renal cyst is exceptional. Likewise, the treatment to be carried out, in these rare cases, is controversial, with respect to opting for radical renal surgery. METHODS: We present the case of a patient with a solid nodule in a large cyst. Complete removal of the cyst was performed by transperitoneal laparoscopic technique. The histopathological study of the surgical piece revealed the existence of a cyst with clear renal cell carcinoma with nucleolar grade 2. The clinical evolution has been satisfactory, performing a minimally invasive surgery (laparoscopic cyst excision). DISCUSSION: Although it is considered that surgical treatment of choice is radical surgery in these cases, we believe that nephron sparing surgery may represent a therapeutic option, taking into account the young age of our patient. A histogenetic hypothesis is discussed to explain the appearance of a clear cell tumor in a simple renal cyst. CONCLUSION The development of a renal cell carcinoma in simple renal cysts is a very infrequent pathology.Laparoscopic total cystectomy is a minimally invasive therapeutic option for the treatment of renal cell carcinoma originating in a simple renal cyst, although it is of an important size. We establish the hypothesis of migration of the cells of the renal collecting tubes into the cyst wall to explain the malignant transformation of the renal simple cyst.
Collapse
Affiliation(s)
- Álvaro Serrano
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - María Sánchez
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - Marco Ciappara
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - Eduardo López
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - Silvia Laso
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - Tamara Jerez
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - Jerónimo Barrera
- Servicio de Radiodiagnóstico. Hospital Clínico San Carlos. Madrid. España
| | - José Antonio Cortés
- Servicio de Anatomía Patológica. Hospital Clínico San Carlos. Madrid. España
| | - Pilar González-Peramato
- Servicio de Anatomía Patológica. Hospital Universitario La Paz. Facultad de Medicina. Universidad Autónoma. Madrid. España
| | - Jesús Blazquez
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| | - Jesús Moreno
- Servicio de Urología. Hospital Clínico San Carlos. Madrid. España
| |
Collapse
|
16
|
Bonnevie F, Meunier P, Andrianne R. [Cystic nephroma : a rare kidney neoplasm]. Rev Med Liege 2019; 74:125-128. [PMID: 30897310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cystic nephroma is a rare kidney neoplasm belonging to the entity of cystic tumours. It is a slow-growing tumour, which develops insidiously, sometimes reaching a considerable size. The diagnosis is more often accidental (except for mass syndrome in children). It is a benign tumour that may be treated by partial sparing nephrectomy. Malignant degeneration is few and far between. However, no medical examination can confirm the diagnosis before surgery. On medical imaging, the tumour enhances after contrast injection and there will always be a doubt about the benignity. Furthermore, percutaneous biopsy of the mass is not contributory to the diagnosis. This means that it is not easy to propose a conservative surgical treatment, even though this remains the best way to deal with such a tumour.
Collapse
Affiliation(s)
- F Bonnevie
- Service de Chirurgie, CHU Liège, Belgique
| | - P Meunier
- Service de Radiodiagnostic, CHU Liège, Belgique
| | | |
Collapse
|
17
|
Zhang Z, Zhang Y, Wang X, Chen D, Peng N, Chen J, Bleyer A, Wang Q, Liu Y, Zhang Y. Challenges in the diagnosis of calyceal diverticulum: A report of two cases and review of the literature. J Xray Sci Technol 2019; 27:1155-1167. [PMID: 31476195 DOI: 10.3233/xst-190549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Calyceal diverticula outpouchings that occur rarely in the upper collecting system of the kidney and is often difficult to detect. In this study, we present two cases of calyceal diverticula and discuss their clinical characteristics and radiologic features. PATIENTS AND METHODS In the presented two cases, we applied several imaging examinations, including delayed intravenous pyelography, retrograde pyelography and axial computerized tomographic (CT) scanning of the kidneys with and without contrast. Serum creatinine levels in fluid withdrawn from the diverticula were found to be significantly higher than the simultaneous serum creatinine levels. Intravenous injection of methylene blue through a ureteral catheter was also aided in the diagnosis. Calyceal diverticulum neck dilatation was performed through a percutaneous nephroscope.ResultsThe two cases were diagnosed preoperatively and the operation was successful performed. The nephrostomy tube was removed seven days after surgery without complications. CT scans of the kidney after six months showed that the size of the calyceal diverticulum of two patients were considerably smaller than pre-surgery. There were no reports of pain in the lumbar region or other discomfort. COMMENTS Diagnosis of calyceal diverticulum mainly depend on a variety of imaging examinations, including the delayed intravenous pyelography, retrograde pyelography, and kidney CT plain scan plus enhanced scan. If the patient cannot be diagnosed by above methods, cyst fluid can be aspirated percutaneously to measure the preoperative creatinine level. If it is significantly higher than the serum creatinine level, the cyst fluid is considered urine, which can assist in the diagnosis of calyceal diverticulum. A ureteral catheter should also be inserted before operation namely, intravenous injection of methylene blue through a ureteral catheter is helpful for diagnosis. The choice of surgical treatment is based on the size and location of calyceal diverticulum and clinical manifestations.
Collapse
Affiliation(s)
- Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Yixiang Zhang
- Department of Urology, Shenzhen People's Hospital, Guangdong, Shenzhen, China
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Dong Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Jicheng Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Anthony Bleyer
- Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Qinjun Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Yunfei Liu
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
18
|
Kadyrov ZA, Demin NV, Sarukhanyan OO, Shvelidze MG. [Retroperitoneoscopic resection of the calyceal diverticulum wall in an 8-year-old child]. Urologiia 2018:130-134. [PMID: 30761803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A renal calyceal diverticulum is a cystic cavity within the renal parenchyma, which is lined by transitional epithelium and communicates with the calyx or, more rarely, the renal pelvis. In children, this anomaly is extremely rare. The article describes the resection of the middle calyceal diverticulum in an 8-year-old child using retroperitoneoscopic access.
Collapse
Affiliation(s)
- Z A Kadyrov
- Research Institute of Emergency Pediatric Surgery and Traumatology of MHD, Moscow, Russia
- Department of Endoscopic Urology, FPE of the RUDN University, Moscow, Russia
| | - N V Demin
- Research Institute of Emergency Pediatric Surgery and Traumatology of MHD, Moscow, Russia
- Department of Endoscopic Urology, FPE of the RUDN University, Moscow, Russia
| | - O O Sarukhanyan
- Research Institute of Emergency Pediatric Surgery and Traumatology of MHD, Moscow, Russia
- Department of Endoscopic Urology, FPE of the RUDN University, Moscow, Russia
| | - M G Shvelidze
- Research Institute of Emergency Pediatric Surgery and Traumatology of MHD, Moscow, Russia
- Department of Endoscopic Urology, FPE of the RUDN University, Moscow, Russia
| |
Collapse
|
19
|
Affiliation(s)
- G Polat
- From the Department of Radiology, Medical Faculty, Ataturk University, 25040 Erzurum, Turkey
| | - B Pirimoglu
- From the Department of Radiology, Medical Faculty, Ataturk University, 25040 Erzurum, Turkey
| | - R Sade
- From the Department of Radiology, Medical Faculty, Ataturk University, 25040 Erzurum, Turkey
| | - M Kantarci
- From the Department of Radiology, Medical Faculty, Ataturk University, 25040 Erzurum, Turkey
| |
Collapse
|
20
|
Topaktas R, Akkoc A, Altin S, Aydin C, Urkmez A. Effectiveness of harmonic scalpel in laparoscopic treatment of simple renal cyst. J PAK MED ASSOC 2018; 68:1124-1128. [PMID: 30317318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We retrospectively evaluated the results of Harmonic Scalpel (Ethicon, Cincinnati, Ohio) used for laparoscopic decortication of simple renal cysts (SRC). Between May 2011 and December 2014, 28 patients with symptomatic SRC (Bosniak type 1) underwent laparoscopic decortication with Harmonic Scalpel, were reviewed. All cysts were evaluated with ultrasonography and abdominal computed tomography. Symptomatic and surgical success was defined as no recurrence on computed tomography imaging and complete pain relief, respectively. The mean age of patients was 51.7±9.6 years and there were 16 female and 12 male. While a transperitoneal approach was preferred in 18 cases, a retroperitoneal approach was chosen in 10 patients. The mean cyst size and duration of operation was 8,8±2,8 (6-12) cm and 72,8±28,4 (50-110) minutes, respectively. A total of three minor complications were observed postoperatively. Mean hospital stay was 1,3±0,9 (1-3) days. After the mean 12,6±3,2 (3-24) months follow-up the radiological and symptomatic successes were 100% and 89,2%, respectively. Our results showed that laparoscopic decortication of SRC using Harmonic Scalpel is consistent with the literature and provides a reasonable complication but increases cost.
Collapse
Affiliation(s)
- Ramazan Topaktas
- Haydarpasa Numune Training and Research Hospital, Clinic of Urology, Istanbul
| | - Ali Akkoc
- Diyarbakir Gazi Yasargil Training and Research Hospital, Clinic of Urology, Diyarbakir, Turkey
| | - Selcuk Altin
- Diyarbakir Gazi Yasargil Training and Research Hospital, Clinic of Urology, Diyarbakir, Turkey
| | - Cemil Aydin
- Diyarbakir Gazi Yasargil Training and Research Hospital, Clinic of Urology, Diyarbakir, Turkey
| | - Ahmet Urkmez
- Haydarpasa Numune Training and Research Hospital, Clinic of Urology, Istanbul
| |
Collapse
|
21
|
Darenkov SP, Proskokov AA, Agabekian AA, Trofimov IA. [The incidence of malignant transformation of renal cysts of category 1, 2, and 2F by the BOSNIAK classification into multilocular cystic renal cell carcinoma]. Urologiia 2018:111-115. [PMID: 30035429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
RELEVANCE Renal cysts remain the most common of benign renal lesions, but current literature is lacking large observational studies on the incidence of their malignant transformation. AIM To assess the incidence of malignant transformation of renal cysts of category 1, 2, and 2F by the Bosniak classification into multilocular cystic renal cell carcinoma. MATERIALS AND METHODS From January 2009 to December 2017, 177 patients with renal cysts of category 1 (n=50), 2 (n=74), and 2F (n=53) underwent laparoscopic decortication. In 10 cases, post-operative histological and immunohistochemical studies revealed foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma. RESULTS Foci of grade 1 (pT1a) multilocular cystic renal cell carcinoma were detected in 10 (5.65%) patients (five men, five women, mean age 58.9 years). The incidence of malignant transformation of renal cysts of categories 1, 2, and 2F was 0%, 2.7% (2 of 74 patients), and 15.1% (8 of 53 patients), respectively. Subsequently, all ten patients were submitted to surgical treatment: eight of them underwent a partial nephrectomy, and two received a nephrectomy. During a median of 49.3 (31-72) months follow-up, no metastasis, and recurrence of multilocular cystic RCC were observed. CONCLUSION A more modern algorithm for managing patients with Bosniak category 1, 2 and 2F cysts need to be developed to establish early surveillance of patients starting with category 1 cysts. Given the low malignant potential of these tumors, they should be treated with organ-sparing surgery.
Collapse
Affiliation(s)
- S P Darenkov
- Department of Urology, Central State Medical Academy at the Administrative Directorate of the President of the RF
- Clinical Hospital at the Administrative Directorate of the President of the RF, Moscow, Russia
| | - A A Proskokov
- Department of Urology, Central State Medical Academy at the Administrative Directorate of the President of the RF
- Clinical Hospital at the Administrative Directorate of the President of the RF, Moscow, Russia
| | - A A Agabekian
- Department of Urology, Central State Medical Academy at the Administrative Directorate of the President of the RF
- Clinical Hospital at the Administrative Directorate of the President of the RF, Moscow, Russia
| | - I A Trofimov
- Department of Urology, Central State Medical Academy at the Administrative Directorate of the President of the RF
- Clinical Hospital at the Administrative Directorate of the President of the RF, Moscow, Russia
| |
Collapse
|
22
|
La Russa A, Cifarelli RA, Perri A, Saracino A, Santarsia G, Bonofiglio R. [Identification of a new mutation of the NPHP1 gene]. G Ital Nefrol 2018; 35:2018-vol3-12. [PMID: 29786190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Kidney cystic diseases are inherited disorders causing chronic renal failure. According to the genetic defect they are classified as diseases of the primary ciliary complex and uromodulin-associated diseases. Mutations in genes coding for ciliary proteins are the basis of a broad category of genetic diseases, called ciliopathies. To date, three important ciliopathies are known: the autosomal dominant form and the recessive shape of the polycystic kidney and the nephronophthisis (NPHP). Juvenile Nephronophthisis (NPHP) is a progressive renal tubulo-interstitial disorder with a form of autosomal recessive inheritance that progresses inexorably towards terminal renal failure. Three different forms have been distinguished: juvenile (NPH1), infantile (NPH2) and adolescent (NPH3). Juvenile Nephronophthisis or nephronophthisis type 1 (NPH1), is the most frequent form. In most patients with a suspected diagnosis of NPHP, based primarily on clinical and radiological data, the deletion in homozygous NPHP1 is present in 20-40% of cases. Heterozygous deletions are found in 6% of patients, with concomitant mutation of the NPHP1 gene on the second allele. In this study we subjected to genetic screening 6 patients with suspected NPHP causing chronic renal failure, belonging to 6 families. The genetic screening identified in 2/6 patients a deletion of exons 5-7-20 and in 4/6 patients an heterozygous deletion of exon 20 and an heterozygous deletion on exon 17 not yet described in literature. Our results suggest that genetic screening should be included in the diagnostic procedure of patients with suspected nephronophthisis and that it may be used alternatively to renal biopsy.
Collapse
Affiliation(s)
- Antonella La Russa
- Centro di Ricerca "Rene e Trapianto" UOC Nefrologia e Dialisi abilitata al Trapianto, AO Cosenza, Italia
| | - Rosa Anna Cifarelli
- Fondazione Basilicata - Ricerca Biomedica, Madonna delle Grazie, Matera, Italia
| | - Anna Perri
- Centro di Ricerca "Rene e Trapianto" UOC Nefrologia e Dialisi abilitata al Trapianto, AO Cosenza, Italia
| | - Angelo Saracino
- Unità Operativa Complessa "Nefrologia Dialisi e CRT-Centro Regionale Trapianti", Matera, Italia
| | - Giovanni Santarsia
- Unità Operativa Complessa "Nefrologia Dialisi e CRT-Centro Regionale Trapianti", Matera, Italia
| | - Renzo Bonofiglio
- Centro di Ricerca "Rene e Trapianto" UOC Nefrologia e Dialisi abilitata al Trapianto, AO Cosenza, Italia
| |
Collapse
|
23
|
Affiliation(s)
- A J Wakefield
- Department of Paediatric Urology, St George's Hospital, London
| | | |
Collapse
|
24
|
Abstract
A classification system of renal cysts developed by Bosniak is based on computed tomography (CT) findings and has been applied to deal with the complex cystic renal masses. Magnetic resonance (MR) has excellent soft-tissue resolution, it has been used to further evaluate some complex renal lesions, especially those suspected of containing soft tissue components and hyperattenuating cystic lesions seen on CT. Compared with CT, MR images may find additional information, which may lead to inconsistent classification. However, at present, there is no consensus on the treatment of these inconsistent lesions. This study aimed to investigate the value of MR in the evaluation of renal cystic masses by using the Bosniak classification system and improve understanding of the MR features of renal cyst masses.The present study retrospectively analyzed 35 renal cyst masses in 34 patients (10 men and 24 women with age from 20 to 65 years old, with an average of 49 ± 12.08), who underwent both MR and computed tomography (CT) examinations within 6 months (range from 1 to 135 days with an average of 11 ± 24.16 days). Twenty-four lesions (9 category III and 15 category IV on CT) received surgical treatment, 4 category IIF lesions on CT were upgraded to category III on MR, which were finally accepted operative resection. The remaining 7 lesions (category II-IIF on both CT and MR) were followed up for at least 3 years. For each lesion, size of both cyst and solid component, presence of calcification, number of septa, thickness of wall and septa, and appearance of enhancement were analyzed. Each lesion was categorized by using Bosniak criteria on CT and MR, respectively. The MR findings were compared with CT and pathology or follow-up results.On MR, categories of the lesions were as follows: category IIF (n = 7), III (n = 12), IV (n = 16). On CT, categories of the lesions were as follows: II (n = 3), IIF (n = 8), III (n = 9), and IV (n = 15). Findings on MR and CT images were inconsistent in 8 (23%) lesions. Among them, 3 category II lesions on CT were classified as category IIF on MR images, 4 category IIF lesions on CT were upgraded to category III on MR, and 1 category III lesions to category IV. In these lesions, MR detected more increased wall/septa thickness (n = 8) and septa number (n = 3) than CT, resulting in an upgrade in classification. Based on the pathological results, 5 of category III (5/9, 56%) and all category IV (15/15, 100%) lesions on CT images were malignant. On MR, 4 of category III (4/12, 33%) and all category IV (16/16, 100%) lesions were malignant.The renal cyst masses in some cases, especially category II to III lesions, may be over evaluated by the Bosniak criteria based on MR findings. It is necessary to combine MR features with CT findings in evaluation and management of these cases with renal cystic masses.
Collapse
Affiliation(s)
- Jianguo Zhong
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine
- Department of Radiology, Zhejiang Provincial People’ Hospital, People’ Hospital of Hangzhou Medical College, Hangzhou, China
| | - Fang Cao
- Department of Radiology, Zhejiang Provincial People’ Hospital, People’ Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine
| | - Junfa Chen
- Department of Radiology, Zhejiang Provincial People’ Hospital, People’ Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People’ Hospital, People’ Hospital of Hangzhou Medical College, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine
| |
Collapse
|
25
|
Affiliation(s)
- Yaolin Zhou
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City; Department of Pathology, University of Alabama at Birmingham.
| | - Shi Wei
- Department of Pathology, University of Alabama at Birmingham
| |
Collapse
|
26
|
Lai S, Xu X, Diao T, Jiao B, Jiang Z, Zhang G. The efficacy of retroperitoneal laparoscopic deroofing of simple renal cyst with perirenal fat tissue wadding technique: A retrospective study. Medicine (Baltimore) 2017; 96:e8259. [PMID: 29019896 PMCID: PMC5662319 DOI: 10.1097/md.0000000000008259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Treatment options for simple renal cyst (SRC) include open surgery, laparoscopy with decortication, or percutaneous aspiration with or without sclerotherapy. Though laparoscopic unroofing achieves better results than percutaneous sclerotherapy, the reported recurrence rate is still up to 19%. Thus, it is necessary to find methods to reduce the recurrence rate.To investigate whether the perirenal pedicled fat tissue wadding technique during retroperitoneal laproscopic deroofing (RLD) of SRC affects the incidence of recurrence.A retrospective analysis was carried out on clinical data of 254 patients with SRC treated by RLD in our hospital from 2008 to 2016. Among these patients,119 had a simple retroperitoneal deroofing (SRD) and 135 received a retroperitoneoscopic deroofing with wadding of the cyst using perirenal fat tissue (RDCW). The recurrence rate and variables, as well as perioperative complications, were compared. To further explore the potential variables influencing cyst recurrence rate, univariate and multivariate regression analyses were applied.A total of 251 patients were included in the analysis. The operation was successfully completed laparoscopically in all cases with no conversion to open surgery. No mortality or significant complication occurred in both groups. After a median follow-up of 38.67 months, we noted 41 recurrences. According to the univariate and multivariate regression analyses, patients managed with the wadding technique had superior recurrence-free survival (RFS), compared with patients in SRD group (log-rank P = .03 and P = .04, respectively). Moreover, patients with single renal cyst had a lower recurrence rate, compared with patients with multiple renal cysts (log-rank P < .01). Regarding the operation time, blood loss, and hospital stay, no statistically significant difference was found between 2 groups (P values .13, .30, and .75, respectively). However, less postoperative drainage and shorter postoperative interval until tube removal (P = .04) were observed in RDCW group.The perirenal pedicled fat tissue wadding technique can decrease the cyst recurrence rate and RCDW represents an effective and safe treatment option in the management of renal cysts.
Collapse
Affiliation(s)
- Shicong Lai
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Xin Xu
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Tongxiang Diao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| | - Zhaoqiang Jiang
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Beijing
| |
Collapse
|
27
|
Abstract
AIM Our aim is to present a case of a rare disorder, such as Joubert syndrome (JS) which required oral surgical intervention under general anesthesia at a very young age to help in achieving normal developmental milestones. BACKGROUND Ciliopathies are an emerging class of diseases of which JS is a significant member. There have been very few cases of JS with its distinguishing features which have been reported in recent literature. CASE REPORT We herewith present a case of JS who reported to our unit with a complaint of speech abnormality. Intraoral examination revealed a tongue-tie which was planned for surgical release. As any drugs that interfere with respiratory depression have to be used with utmost care, adequate precautions were taken in this case and the patient was treated under general anesthesia. The tongue-tie was released and associated ham-artomatous outgrowths from the floor of the mouth were also excised. Appropriate postoperative care was taken and the patient was discharged. CONCLUSION The patient treated by us did not reveal any significant intraoperative or postoperative complications. Treatment of cases of JS required a team effort of multiple dental and medical specialists. Long-term follow-up of such patients is required so that they achieve normal chronological development. CLINICAL SIGNIFICANCE Joubert syndrome being a rare disorder requires special anesthetic care during any surgical procedure, especially that involving the oral cavity. The need and timing of surgical intervention in such cases should be carefully assessed and appropriate precautions should be taken.
Collapse
Affiliation(s)
- Vivek Gurjar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Medical College and Hospital Sangli, Maharashtra, India, e-mail:
| | - Minal Gurjar
- Department of Periodontics, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra India
| | - Channaveer Pattanshetti
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Medical College and Hospital Sangli, Maharashtra, India
| | - Banashree Sankeshwari
- Department of Prosthodontics, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra India
| |
Collapse
|
28
|
Sabarwal VK, Chandrasekar A, Engel J, Toubaji A, Engel JD. A Retroperitoneal Serous Cystadenoma of Müllerian Origin Masquerading as a Massive Renal Cyst. Urology 2017; 105:e9-e10. [PMID: 28408339 DOI: 10.1016/j.urology.2017.03.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 11/17/2022]
Abstract
A 78-year-old woman presented to the urology clinic with a large, symptomatic left-sided abdominal cyst that was believed to be renal in etiology for many years and that had been percutaneously drained 3 times previously with persistent regrowth. The patient underwent laparoscopic resection of this mass, which proved to be a completely distinct retroperitoneal cystic structure and was not renal in nature. Pathologic analysis ultimately revealed a rare occurrence: a benign retroperitoneal Müllerian serous cystadenoma. To our knowledge, this is the first report of such an entity "disguised" as a renal cyst.
Collapse
Affiliation(s)
- Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, DC.
| | | | - Joshua Engel
- Department of Biology, Duke University, Washington, DC
| | - Antoun Toubaji
- Department of Pathology, George Washington University, Washington, DC
| | - Jason D Engel
- Department of Urology, George Washington University, Washington, DC; Urologic Surgeons of Washington, Washington, DC
| |
Collapse
|
29
|
Zaporozhchenko BS, Kolodiy VV, Gorbunov AA, Zaporozhchenko MB, Muravyev PT, Kholodov IG. [LIFTING LAPAROSCOPY IN SIMULTANT SURGERY]. Klin Khir 2017:5-8. [PMID: 30273466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Results of treatment of 84 patients, to whom simultant operative interventions on abdominal, the small pelvis and retroperitoneal organs were performed for concomitant somatic diseases, were analyzed. The author’s technology of laparolifting was applied in 36 patients, and classical technology with carboxyperitoneum adjustment - in 48. Variants of optimal operative accesses were determined, structure and rate of postoperative complications, peculiarities of the early postoperative period course studied. Indisputable advantages of the lifting laparoscopic operations were established, including reduction of the postoperative complications rate and severity, the postoperative pain syndrome intensity, the concurrent chronic diseases exacerbation rate, and postoperative stationary stay.
Collapse
|
30
|
Shlomin VV, Grebenkina NI, Bondarenko PB, Puzdriak PD, Dorofeev SI, Piaterichenko IA, Vereshchako GA. [Open surgical treatment of a giant renal cyst on the background of an arteriovenous fistula of the right renal artery]. Angiol Sosud Khir 2017; 23:163-166. [PMID: 28902828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Presented herein is a clinical case report concerning open surgical treatment of an arteriovenous fistula of the renal artery with a large venous aneurysm in the hilum of the right kidney and a giant cyst of the upper pole in a 28-year-old woman. The intraoperative findings revealed disunion of the arteriovenous fistula, followed by edge-to-edge suturing of the arterial defect. The venous aneurysm in the hilum of the right kidney was dissected and sutured by the edge-to-edge technique, with the additional varicose renal vein ligated. The postoperative period turned out to be uneventful with favourable convalescence and no complications. The check MSCT angiography performed 3 months later showed that the venous aneurysm was thrombosed, with no evidence of arterial blood ingress revealed. The excretory function of the kidney was preserved. Also discussed in the article are variants of diagnosis and treatment of an arteriovenous fistula of this localization and complications thereof.
Collapse
Affiliation(s)
- V V Shlomin
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| | - N Iu Grebenkina
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| | - P B Bondarenko
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| | - P D Puzdriak
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| | - S Ia Dorofeev
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| | - I A Piaterichenko
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| | - G A Vereshchako
- Department of Vascular Surgery, Municipal Multimodality Hospital No2, Saint Petersburg, Russia
| |
Collapse
|
31
|
Forbes AS, Yeo FE. Secondary Hypertension, Erythrocytosis, and Unilateral Renal Cystic Disease in a Submariner: A Case Report. J Spec Oper Med 2016; 16:1-5. [PMID: 28088811 DOI: 10.55460/eyn1-4k34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
Erythrocytosis, or increased red blood cell mass, may be primary as in the case of polycythemia vera (PV), or secondary due to a variety of causes related to erythropoietin (EPO) secretion and hypoxia. Chronic pulmonary disease and certain EPO-secreting tumors should be addressed and excluded early during the course of evaluation for a patient presenting with increased red blood cell mass. Inclusion of the JAK2 V617F gene mutation in the recent World Health Organization criteria for the diagnosis of PV allows for facilitated diagnosis and guides therapy. EPO levels can be helpful in diagnosis and guiding therapy, but in the case of cystic renal diseases, EPO levels are often not elevated, creating diagnostic uncertainty. This report describes a case of symptoms directly attributable to erythrocytosis in the setting of negative JAK2 mutation and normal EPO levels. The subsequent discovery of a large cystic renal kidney and PV were the leading diagnostic considerations.
Collapse
|
32
|
Ozcan L, Polat EC, Onen E, Cebeci OO, Memik O, Voyvoda B, Ulukaradag E, Kara BY. Comparison between Retroperitoneal and Transperitoneal Approaches in the Laparoscopic Treatment of Bosniak Type I Renal Cysts: A Retrospective Study. Urol J 2015; 12:2218-2222. [PMID: 26341761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 06/29/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decortication of simple renal cysts with respect to safety, postoperative pain, and clinical results. MATERIALS AND METHODS The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and physical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creatinine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal computed tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain. RESULTS The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min., and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P < .05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient. CONCLUSION We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain.
Collapse
Affiliation(s)
- Levent Ozcan
- Department of Urology, Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Emre Can Polat
- Department of Urology, Facultyy of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Efe Onen
- Department of Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Oguz Ozden Cebeci
- Department of Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Omur Memik
- Department of Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Bekir Voyvoda
- Department of Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Emre Ulukaradag
- Department of Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | | |
Collapse
|
33
|
Pryanichnikova MB, Pikalov SM, Ivanov SA, Zhdanova AN. [RENAL ECHINOCOCCOSIS]. Urologiia 2015:94-96. [PMID: 26859949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The article summarizes data on the prevalence, clinical manifestations, diagnosis and treatment of renal echinococcosis. The clinical observation of the disease lasted for 10 years is presented. At the beginning, the character of the small (1.5 x 2 cm) renal cyst was difficult to determine. And lack of case follow-up led to the pronounced renal injury, which required the nephrectomy.
Collapse
|
34
|
Lanchon C, Fiard G, Long JA. [Management of cystic renal masses: Review of the literature]. Prog Urol 2015; 25:675-82. [PMID: 26138648 DOI: 10.1016/j.purol.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The expansion of renal cysts diagnosis in the population entails to learn how to properly identify and treat potentially malignant lesions. The aim of this review article is to discuss anatomical and pathological characteristics as well as treatment of cystic renal tumors. METHOD A literature review of Medline publications on renal cysts and cystic tumors was conducted. Prospective and retrospective studies in adults, and previous reviews were analyzed. RESULTS Bosniak classification of renal cysts is used worldwide among urologists and radiologists to categorize cystic lesions according to their potential malignancy. There is a 0, 15, 50 and 95 % chance of cancerous cells in Bosniak I, II, III, and IV, respectively. The most frequent pathology is renal cell carcinoma, usually low grade and low stage. Category IIF cysts (F for follow-up) have a 25 % chance of malignancy and require surveillance at 6 months and regularly for 5 years. The follow-up can be done with CT imaging, MRI or contrast enhanced ultrasonography. Cyst biopsy, which was not recommended for a long time, could prevent 40 % of unnecessary surgeries for benign lesions. Bosniak category I and II cysts can be treated if symptomatic, by sclerotherapy or laparoscopic deroofing of the cyst. Category III and IV lesions must be treated as malignant tumors with security margins. CONCLUSION Diagnosis and treatment of Bosniak category IIF renal cysts remain the primary challenge for physicians in cystic renal tumor management. Biopsies of renal cysts seem reliable, with no risk of malignant cell dissemination.
Collapse
Affiliation(s)
- C Lanchon
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France
| | - G Fiard
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France
| | - J-A Long
- Service d'urologie et transplantation rénale, CHU de Grenoble, 38043 Grenoble cedex 9, France; Laboratoire TIMC-IMAG, domaine de la Merci, 38700 La Tronche, France.
| |
Collapse
|
35
|
Boulma R, Gargouri MM, Chlif M, Sellami A, Ben Rhouma S, Nouira Y. [Atypical renal cysts]. Tunis Med 2015; 93:386-388. [PMID: 26644103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management. AIM To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features. METHODS Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings. RESULTS According to histological findings, 7 among the 10 type III lesions were benign (70%). However, only one case of benign tumor was noted in type IV lesions (8.3%). There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors. CONCLUSION Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible.
Collapse
|
36
|
Siegel C. Re: efficacy of imaging-guided percutaneous radiofrequency ablation for the treatment of biopsy-proven malignant cystic renal masses. J Urol 2014; 191:1730. [PMID: 25280275 DOI: 10.1016/j.juro.2014.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
|
37
|
Carrafiello G, Dionigi G, Ierardi AM, Petrillo M, Fontana F, Floridi C, Boni L, Rovera F, Rausei S, Mangano A, Spampatti S, Marconi A, Carcano G, Dionigi R. Efficacy, safety and effectiveness of image-guided percutaneous microwave ablation in cystic renal lesions Bosniak III or IV after 24 months follow up. Int J Surg 2014; 11 Suppl 1:S30-5. [PMID: 24380547 DOI: 10.1016/s1743-9191(13)60010-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF THE STUDY The aim of the study was to assess the efficacy, safety and effectiveness of percutaneous image-guided microwave ablation (MWA) in Bosniak category III or IV cystic renal lesions after 24 months follow-up duration. METHODS Between May 2008 and December 2012, computed tomography (CT)- or ultrasound (US)-guided MWA was performed in 6 patients with 7 cystic renal lesions (range 13.8-27 mm, mean 17.02 mm, SD 8.5 mm) Bosniak category III or IV. The number of treatment sessions, treatment results, lesion size changes and complications were evaluated. Technical success (TS), technical effectiveness (TE), local tumor progression rate (LTPR), cancer-specific survival rate (CSSR) and overall survival rate (OSR) were computed. MAIN FINDINGS TS was 100% (7/7) and TE was 100%; LTPR was 0%; CSSR and OSR were 100%. No major complications were observed. CONCLUSION Our preliminary experience with MWA shows a potential role for US/CT-guided percutaneous MWA in treating Bosniak category III or IV cystic renal lesions, as a safe approach to treat selected patients not suitable for surgery.
Collapse
Affiliation(s)
- Gianpaolo Carrafiello
- Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy
| | | | - Anna Maria Ierardi
- Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy
| | - Mario Petrillo
- Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy
| | - Federico Fontana
- Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy
| | - Chiara Floridi
- Interventional Radiology - Department of Radiology, University of Insubria, Varese, Italy
| | - Luigi Boni
- Department of Surgery - University of Insubria, Varese, Italy
| | | | - Stefano Rausei
- Department of Surgery - University of Insubria, Varese, Italy
| | - Alberto Mangano
- Department of Surgery - University of Insubria, Varese, Italy
| | | | - Alberto Marconi
- Division of Urology - Ospedale di Circolo, Fondazione Macchi, Varese, Italy
| | - Giulio Carcano
- Department of Surgery - University of Insubria, Varese, Italy
| | - Renzo Dionigi
- Department of Surgery - University of Insubria, Varese, Italy
| |
Collapse
|
38
|
Qiu M, Lu J, Ma LL, Yan Y, Zhang SD. [Retroperitoneal laparoscopic partial nephrectomy for treatment of cystic nephroma: one case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2014; 46:650-652. [PMID: 25131488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The clinical features and pathologic findings of one case of cystic nephroma was reported,and the safety of treatment by retroperitoneal laparoscopic partial nephrectomy evaluated. The patient was a 20-year-old woman, and found left renal cyst for 1 year with pain in her left flank one month ago. The patient was diagnosed as complex renal cyst, then underwent retroperitoneal laparoscopic partial nephrectomy. In the operation, the tumor was located in the middle and lower part of her left kidney, with a number of small sample masses, and a solid mass near the renal parenchymal part. The operation time was 224 min, and the artery occlusion time was about 17 min. The blood loss was 20 mL, with no blood transfusion. The pathology was cystic nephroma. No operation complication was seen, nor was recurrence after a short-term follow-up. Cystic nephroma is a relatively rare benign lesion of the kidney. Retroperitoneal laparoscopic partial nephrectomy is a safe and effective way to treat cystic nephroma.
Collapse
Affiliation(s)
- Min Qiu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lu-lin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Shu-dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|
39
|
Akca O, Zargar H, Autorino R, Brandao LF, Laydner H, Krishnan J, Samarasekera D, Li J, Haber GP, Stein R, Kaouk JH. Robotic partial nephrectomy for cystic renal masses: a comparative analysis of a matched-paired cohort. Urology 2014; 84:93-8. [PMID: 24821467 DOI: 10.1016/j.urology.2014.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the outcomes of robotic partial nephrectomy (RPN) for cystic and solid renal neoplasms. METHODS Our RPN database was queried to identify consecutive patients who underwent RPN for cystic and solid renal masses in the period between July 2007 and July 2013. Cystic renal masses were diagnosed on cross-sectional imaging (computed tomography or magnetic resonance imaging). Matching was done between the patients with cystic renal masses and patients with solid renal masses (1:1 matching) by age, gender, tumor size, and nephrometry score. RESULTS Of 647 cases, 55 patients with cystic masses (group 1) were matched with 55 patients with solid tumors (group 2). There was no cyst rupture or positive surgical margin observed in group 1. The volume of resected rim of healthy renal parenchyma surrounding the tumor was the same for both groups (P=.9). There was no difference between the groups in terms of percentage of glomerular filtration rate preservation postoperatively (85% vs 86%; P=.94). There was no difference in term of overall complications between the 2 groups. Thirty patients (54.5%) in group 1 and 47 patients (85.5%) in group 2 had renal cell carcinoma (P=.0001). CONCLUSION RPN can be safely and effectively performed when treating a suspicious cystic renal neoplasm with outcomes resembling those obtained for solid masses. Thus, when a cystic renal mass in encountered, nephron-sparing surgery can be offered and RPN represents an effective tool for this approach.
Collapse
Affiliation(s)
- Oktay Akca
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Humberto Laydner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jayram Krishnan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Jianbo Li
- Quantitative Health Service, Cleveland Clinic, Cleveland, OH
| | | | - Robert Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
40
|
Aicha BS, Nada S, Sondes S, Manef G, Fatma F, Mourad H. [Pyogenic cyst in childhood]. Tunis Med 2014; 92:349. [PMID: 25504391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
41
|
Gabr AH, Roberts WW, Wolf JS. Hand-assisted and standard laparoscopic radical nephrectomy after prior renal surgery. Can J Urol 2014; 21:7141-7144. [PMID: 24529017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION With the increasing use of partial nephrectomy, cases of ipsilateral tumor recurrence will inevitably occur. We aimed to evaluate the efficacy and feasibility of laparoscopic radical nephrectomy (LRN) for a previously operated kidney, through a case-matched comparison with LRN in patients without prior renal surgery. MATERIALS AND METHODS Among 550 patients who underwent hand-assisted or standard LRN at our institution between August 1996 and January 2013, we identified patients who had prior laparoscopic or open surgical renal surgery. Each study patient was matched 1:2 with patients who had not had prior renal surgery. Matching was exact by surgical approach, gender, side of surgery, and American Society of Anesthesiologists score, and closest possible by age and body mass index. RESULTS LRN was performed in 9 patients (6 hand-assisted and 3 standard) with prior open surgical or laparoscopic renal surgery. There were no conversions to open surgery. Primary surgeon tended to be to attending urologist more often than the trainee in the study compared to the control patients, an indication of increased technical difficulty. Additionally, there were four intraoperative injuries recorded in the study group (44%) and just one such event in the control group (5.6%) (p = 0.0297). CONCLUSIONS Although LRN after prior renal surgery is challenging, requiring the expertise of experienced surgeons and being associated with appreciable rate of intraoperative injuries, these cases can be completed laparoscopically (especially with the selective use of hand-assistance) and are associated with duration of hospitalization and postoperative complication rates similar to those in patients undergoing LRN without prior renal surgery.
Collapse
|
42
|
Özgök Y, Ateş M, Hoşcan MB, İstanbulluoğlu O, Başal Ş, Zor M. Renal cell carcinoma dwelling upon a renal cyst wall and laparoscopic management. Urol J 2014; 10:1165-1167. [PMID: 24469671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/25/2012] [Indexed: 06/03/2023]
Affiliation(s)
- Yaşar Özgök
- Department of Urology, GülhaneMilitary Medical Academy, Ankara,Turkey
| | - Mutlu Ateş
- Department of Urology, GülhaneMilitary Medical Academy, Ankara,Turkey
| | - Mustafa Burak Hoşcan
- Department of Urology, Baskent University, Alanya Research and Practice Center, Alanya-Antalya,Turkey.
| | | | - Şeref Başal
- Department of Urology, GülhaneMilitary Medical Academy, Ankara,Turkey
| | - Murat Zor
- Department of Urology, GülhaneMilitary Medical Academy, Ankara,Turkey
| |
Collapse
|
43
|
Nasseh H, Hamidi Madani A, Ghanbari A, Arfa S. Laparoscopic unroofing of symptomatic kidney cysts. A single center experience. MINERVA UROL NEFROL 2013; 65:285-289. [PMID: 24091481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM This study was aimed to evaluate success and complications of laparoscopic transperitoneal renal cyst unroofing and assess its long-term results at our center. METHODS From October 2008 till April 2012, 23 patients (14 male and 9 female) with a mean age of 53.6 years (range 32-70), underwent transperitoneal laparoscopic renal cyst unroofing at our center. None of the patients, had history of ipsilateral kidney surgery. Complication and outcomes were evaluated. Symptom resolving and disappearance of the cyst or decreasing its size to less than 1/3 of its primary size in radiographies was considered as success. RESULTS Unroofing was achieved in 100% of patients. Mean operative time was 36.6 minutes (range 25 to 60) and mean hospital stay was 3 days (range 2 to 8). No open conversions were necessary during procedure but one patient underwent open exploration hours after laparoscopy because of need to complete hemostasis. Symptomatic and radiologic success was achieved in 91.3% of patients, with a mean follow-up of 15 months (range 3 to 24). One patient developed a recurrence. One ureter stricture revealed in follow up period which needed open uretero-ureterostomy. No visceral complication occurred. CONCLUSION Laparoscopic transperitoneal ureterolithotomy is an effective treatment option for skilled surgeons but care must be taken because complications may occur.
Collapse
Affiliation(s)
- H Nasseh
- Urology Research Center, School of Medicine Guilan University of Medical Sciences, Rasht, Iran
| | | | | | | |
Collapse
|
44
|
Jiménez-León JC, Betancourt-Fursow YM, Jiménez-Betancourt CS. [Central nervous system malformations: neurosurgery correlates]. Rev Neurol 2013; 57 Suppl 1:S37-S45. [PMID: 23897155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Congenital malformations of the central nervous system are related to alterations in neural tube formation, including most of the neurosurgical management entities, dysraphism and craniosynostosis; alterations of neuronal proliferation; megalencefaly and microcephaly; abnormal neuronal migration, lissencephaly, pachygyria, schizencephaly, agenesis of the corpus callosum, heterotopia and cortical dysplasia, spinal malformations and spinal dysraphism. We expose the classification of different central nervous system malformations that can be corrected by surgery in the shortest possible time and involving genesis mechanisms of these injuries getting better studied from neurogenic and neuroembryological fields, this involves connecting innovative knowledge areas where alteration mechanisms in dorsal induction (neural tube) and ventral induction (telencephalization) with the current way of correction, as well as the anomalies of cell proliferation and differentiation of neuronal migration and finally the complex malformations affecting the posterior fossa and current possibilities of correcting them.
Collapse
|
45
|
Zhang YS, Li HZ, Ji ZG, Mao QZ, Rong S, Yan WG, Xiao H, Liu GH, Zhang XB, Xu WF. [Complications of laparoscopic surgery: a 11-year single institute experience]. Beijing Da Xue Xue Bao Yi Xue Ban 2013; 45:584-587. [PMID: 23939167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To analyze the complications of laparoscopic surgery for the past 11 years in the Urology Department of Peking Union Medical College Hospital. METHODS The laparoscopic surgery of 5 386 cases from Jan. 2002 to Dec. 2012 was statistically analyzed. The patient's gender, age, surgery mode, blood loss, complications, total length of hospital stay, postoperative hospital stay and other data were analyzed. RESULTS There were 5 386 cases in this group aged 8-86 years (the mean age: 49.0 years; 2 651 cases were male and 2 735 female). Of all the cases, 2 411 were of adrenal surgery, accounting for 44.7%, 167 of retroperitoneal tumor resection , accounting for 3.1%, 763 of radical nephrectomy surgery, accounting for 14.2%, 441 of partial nephrectomy surgery, accounting for 8.2%, 784 of renal cyst surgery, accounting for 14.6%; 279 of semi-urinary tract resection, accounting for 5.2%; 74 of renal pelvis and ureter plasty, accounting for 1.4%; 141 of radical prostatectomy surgery, accounting for 2.6%, 71 of cystectomy surgery, accounting for 1.3% and 255 of other surgery, accounting for 4.7%. The blood loss was 10-3 000 mL (average: 97.5 mL ) and the surgery requiring blood transfusion treatment involved 270 patients. The total hospital stay was 3-133 days (average: 18 days) and postoperative hospital stay was 2-35 days (average: 6.3 days). All kinds of complications occured in 346 cases (6.42%), of which 198 were of peritoneal injury, 12 of pleural injury; 72 of subcutaneous emphysema, 24 of urinary fistula, 15 of inferior vena cava injury, 6 of pancreatic fistula 10,of lymphatic fistula, 8 of wound delayed healing and 1 of, intestinal fistula. The incidence of the complications and blood transfusion showed a downward trend according to stratified analysis each year. CONCLUSION The laparoscopic surgery coveres almost all treatment of urological diseases. The complications are different in different types of surgery at different times, but generally no serious complications occurr. The incidence of complications is in a downward trend as the laparoscopic technique level improves.
Collapse
Affiliation(s)
- Yu-shi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Vinod V, Kumar A, Sanjeevan KV, Dinesh KR, Karim S. Perinephric abscess due to Achromobacter xylosoxidans following de-roofing of renal cyst. Surg Infect (Larchmt) 2013; 14:422-3. [PMID: 23859686 DOI: 10.1089/sur.2012.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Castillo OA, Rodriguez-Carlin A, Lopez-Fontana G, Aleman E. Robotic partial nephrectomy with selective parenchymal compression (Simon clamp). Actas Urol Esp 2013; 37:425-8. [PMID: 23433637 DOI: 10.1016/j.acuro.2012.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/17/2012] [Accepted: 11/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. MATERIAL AND METHODS In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. RESULTS The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. CONCLUSION Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.
Collapse
Affiliation(s)
- O A Castillo
- Unidad de Urología y Centro de Cirugía Robótica, Clínica INDISA, Santiago, Chile; Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile.
| | | | | | | |
Collapse
|
48
|
Mei F, Qin Y, Gu H, Liu Y, Wang H. [Therapeutic strategy of Bosniak category II renal cyst: a report of 52 cases]. Zhonghua Yi Xue Za Zhi 2013; 93:1897-1899. [PMID: 24124743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the therapeutic strategy of Bosniak category II renal cyst. METHODS A total of 52 cases of Bosniak category II renal cyst underwent surgery from 2004 to 2011. There were 32 males and 20 females with a mean age of 48 years. Their average diameter of renal cysts was 4.7 cm. There were 25 left, 23 right and 4 bilateral lesions. RESULTS Renal cystectomy (n = 47) and radical nephrectomy (n = 5) were performed. Four cases of renal cyst with cystectomy had malignancy confirmed with intraoperative frozen section and underwent radical nephrectomy immediately. One case underwent radical nephrectomy in second stage because of a confirmation of malignant renal cyst after cystectomy. Malignant renal cyst were found in 5 cases and benign lesions in 47. The malignancy rate was 9.6% (5/52) with 14.3% (4/28) in IIF group and 4.2% (1/24) in non-IIF group. Forty-three cases were followed up for 1-8 years with 4 cases of malignancy and 39 cases of benign lesions. One case of malignancy had pulmonary metastasis at 3 years post-operation. CONCLUSIONS Operation should be performed in IIF renal cyst and II cyst with a diameter of >5 cm. Follow-ups should be performed in other category II renal cysts, especially in young patients.
Collapse
Affiliation(s)
- Fang Mei
- Department of Urology, Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | | | | | | | | |
Collapse
|
49
|
Stiefelhagen P. [Continuous right flank pain: what is compressing the kidney?]. MMW Fortschr Med 2013; 155:34. [PMID: 23654129 DOI: 10.1007/s15006-013-0281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Rodríguez Collar TL, Valdés Estévez B, Nuñez Roca A, Germán Meliz JL. Infected simple renal cyst. Case report. ARCH ESP UROL 2012; 65:894-897. [PMID: 23269337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To present a new case of an infected simple renal cyst, its diagnosis and the treatment carried out. METHODS 30 year-old female patient admitted to the Internal Medicine ward suffering a prolonged fever syndrome. On physical examination she presented tachycardia and pain in the left hypochondrium on deep palpation. Abdominal ultrasound revealed the existence of a great size left renal cyst with a highly echogenic content; this liquid hyperdensity was confirmed by simple and i.v. contrast CT scan. RESULTS Cyst punction was performed through a lumbar via, getting approximately 400 millilitres of a clear and odourless yellow liquid; then it was sclerosed with ethanol. The microbiological study of the extracted liquid was negative. The patient's clinical evolution has been satisfactory and renal ultrasound controls were normal. CONCLUSIONS Faced with a simple infected renal cyst whose location allows percutaneous lumbar approach, punction with synchronic sclerosis plus parenteral antibiotic therapy with ciprofloxacin is the recommended treatment.
Collapse
|