Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts

OBJECTIVES: Symptomatic simple renal cysts can be treated by combination of percutaneous aspiration and sclerotherapy. A number of sclerosing agents including glucose, phenol, iophendylate, polidocanol, minocycline and pantopaque have been used in the past to prevent reformation of cyst. In this study, tetracycline HCL solution is evaluated as a sclerosant for treatment of simple renal cysts. METHODS: Our study treated 76 cysts in 70 patients with symptomatic renal cysts. Aspiration and sclerotherapy was performed on 56 cysts, and 20 cysts aspirated without sclerotherapy as a control group. Treatment was performed under local anesthesia and punctured under ultrasound guidances with an 18-gauge needle. Tetracycline HCL (20%) was injected into the cystic cavity according to cyst diameter. All patients were followed up with an ultrasound examination at 3 months, 6 months, and then at yearly intervals. The reduction rate was estimated by a comparison of the volume of the cyst before and after treatment. A cyst reduction of 50% or greater in diamater was considered as a successful treatment. RESULTS: The average follow-up period was 9.8 months in the sclerotherapy group and 9.9 months in the control group. The success rate was 85.7% in the sclerotherapy group. There was a significant difference in the reduction rate of tetracycline HCL sclerotherapy group and control group. No major complications were encountered.     

Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia

ObjetivesChecking the efficiency (cost/benefit) of the sclerotherapy with polidocanol in our country for the treatment of hydrocele and epididymal cystPatient and methodsWe studies 86 patients with this diagnosis from may of 1995, until april of 2000. We have applied the costs for process according to the indicators of administration-cost our hospital in the year 1999Outputs79 patient completed the protocol. The overall cure rate was 83.87% with sclerotherapy; 42.3% with first one treatment. Only a 4.5% of the patients had significant pain and a 7.4% others complicationsDiscussionThere were necessaries 1,5 sclerotherapies of mean for curation, resulting this treatment 4.78 more cheaper than surgeryConclusionThe sclerotherapy with polidocanol of the hydrocele or epididymal cyst are an effective treatment, sure, simple, reasonably comfortable and fundamentally, economical     

Treatment of simple renal cysts with single-session percutaneous ethanol sclerotherapy without drainage of the sclerosing agent

PURPOSE: To evaluate percutaneous single-session sclerotherapy with ethanol without drainage of the sclerosing agent in symptomatic simple renal cysts that require treatment. PATIENTS AND METHODS: A prospective series of 30 consecutive patients with symptomatic simple renal cysts with volume of 280.3 +/- 365.23 mL (range 28-1700 mL) estimated by ultrasonography were treated between July 1999 and July 2003. The cysts were punctured with an 18-gauge, 20-cm needle under ultrasound guidance and local anesthesia. A volume of ethanol equivalent to one third of the aspirated volume, up to a maximum of 100 mL, was injected into the cyst and left there. The patients were reassessed at 1, 3, and 6 months. RESULTS: The procedure was technically feasible in all patients. The aspirated volume was 259.8 +/- 265.2 mL (range 30-1900 mL). After 1, 3, and 6 months, the average volume was 52.7 +/- 71.4 mL, 22.7 +/- 43.2 mL, and 11.6 +/- 30.7 mL, respectively. After this period, 28 patients (93%) were asymptomatic, showing total remission of the cyst (17 cases) or at least a 90% decrease (10 cases) or a 50% decrease (1 case) in the initial volume. One patient (3%) had a 50% reduction of the cyst and persistent symptoms, and one patient (3%) had persisting symptoms despite the total remission of the cyst. CONCLUSION: Single-session percutaneous sclerotherapy with ethanol is a good option for the treatment of symptomatic renal cysts, as it is highly effective and offers the benefits of a less-invasive procedure.     

Povidone-iodine sclerotherapy is ineffective in the treatment of symptomatic renal cysts

PURPOSE: To evaluate the efficacy of povidone-iodine sclerotherapy after percutaneous drainage of simple renal cysts in the treatment of symptomatic patients. PATIENTS AND METHODS: Sixteen patients with symptomatic renal cysts were treated by percutaneous drainage and injection of povidone-iodine solution. The cysts were drained by a nephrostomy tube catheter, and povidone- iodine injections were repeated every 24 hours for 3 days. All patients were followed up by ultrasound examination during a period ranging from 1 to 4 years (mean 1.8 years). RESULTS: Thirteen patients experienced recurrence of cysts, while complete resolution was observed in only three patients. Of the cysts that recurred, only partial resolution in cyst diameter was observed (from 3-10.5 cm to 2.4-8.6 cm). During the follow-up period, 12 of the 16 patients (75%) continued to have pain that necessitated additional treatments. CONCLUSION: Povidone-iodine sclerotherapy is followed by a high rate of recurrence and is therefore not indicated for the treatment of symptomatic simple renal cysts.     

A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts

OBJECTIVES: To present the results of a minimally invasive treatment of symptomatic simple renal cysts, and to propose an algorithm for their management. PATIENTS AND METHODS: Seventeen patients presenting with suspected symptomatic simple renal cysts were referred for trial aspiration; 16 presented with loin pain and one with a flank mass. If the cyst and symptoms recurred after a temporary response, they were managed by re-aspiration with sclerotherapy using 95% ethanol, or by laparoscopic de-roofing of the cyst. RESULTS: Of the 17 patients referred, one failed to respond to aspiration and was excluded from further analysis. Three patients had sustained pain relief from simple aspiration alone, 13 required further treatment for symptom relapse, of whom six had aspiration and sclerotherapy, and seven had laparoscopic de-roofing. After a mean follow-up of 17 months, pain had recurred in all five patients originally presenting with pain and managed by sclerotherapy, and the patient who presented with a painless mass from a large cyst also developed pain after sclerotherapy. In contrast, the subsequent seven patients managed by laparoscopic treatment are pain-free at a mean follow-up of 17.7 months. CONCLUSION: Evaluation including a diagnostic aspiration is essential to diagnose a symptomatic cyst. When treatment is indicated, laparoscopic de-roofing appears to be more effective than sclerotherapy.     

Percutaneous aspiration and alcohol sclerotherapy for symptomatic hepatic cysts. An alternative to surgical intervention.

Eight patients with 15 symptomatic nonneoplastic congenital hepatic cysts underwent ultrasound-guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. All cysts were treated at least twice at the same sitting. The volume of alcohol injected varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one alcohol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. No recurrences were found during a follow-up period of 12 to 32 months. The results indicate that aspiration and alcohol sclerotherapy is a feasible alternative to surgical intervention in patients with symptomatic nonneoplastic congenital hepatic cysts. We recommend it as the treatment of choice in cases with high surgical risk or polycystic liver disease.     

Transrectal ultrasound-guided puncture,drainage, and minocycline hydrochloride sclerotherapy for the symptomatic prostatic cyst

PURPOSE: We treated three patients who had symptomatic prostatic cysts by transrectal ultrasound-guided puncture, drainage, and sclerotherapy. The procedure and the results are described in this report. MATERIALS AND METHODS: The patients were 60, 73, and 78 years old and complained of difficult voiding. With local anesthesia, transrectal ultrasound-guided puncture and drainage were performed, and then 100 mg of minocycline hydrochloride was infused into the cavity of the cyst. We evaluated the International Prostate Symptom Score (IPSS), urodynamic data, volume of residual urine, complications, and recurrence. RESULTS: There were no complications, and improvements of voiding symptoms were experienced without any recurrences within the 2 years or more of follow-up. CONCLUSION: This minimally invasive treatment by transrectal ultrasound-guided puncture, drainage, and minocycline hydrochloride sclerotherapy is suggested to be promising for the symptomatic prostatic cyst.     

Treatment of varicoceles in childhood and adolescence with Tauber's antegrade scrotal sclerotherapy

PURPOSE: The aim of this study was to evaluate surgical complications and the outcome of grade II and III varicoceles treated with Tauber's antegrade scrotal sclerotherapy. METHODS: A total of 21 patients with a median age of 13 (range, 10 to 21) years and left-sided grade II and III varicoceles were treated with Tauber's antegrade scrotal sclerotherapy and underwent follow-up over a median period of 23 months (range, 9 to 35). RESULTS: One grade II varicocele persisted after antegrade sclerotherapy for 6 months. After a second sclerotherapy 6 months later, no further recurrence was detected. One patient with a grade II to III varicocele had a grade I varicocele recurrence 14 months after operation. Three patients showed a slight hydrocele postoperatively. CONCLUSION: This limited series indicates that Tauber's antegrade scrotal sclerotherapy is a safe and effective treatment for grade II and III varicoceles in children and adolescents.     

超声引导下穿刺注入50%葡萄糖治疗肝肾单纯性囊肿

目的探讨超声引导下经皮穿刺使用不同方法注入高渗葡萄糖治疗肝肾囊肿的疗效的可靠性。方法回顾性分析于我院接受超声引导下肝肾囊肿高渗葡萄糖（50％葡萄糖）注入治疗的53例患者（54个囊肿）的资料,根据注入高渗葡萄糖的不同方法进行分组,其中I组24例24个囊肿,使用传统的方法注入高渗葡萄糖进行囊肿治疗,即抽出囊液后注入的葡萄糖的量为抽出囊液量的1／3,Ⅱ组29例30个囊肿,使用改良的高渗葡萄糖注入法,一次或多次注入高渗葡萄糖,使囊肿内葡萄糖的浓度尽量达到50％的高渗环境,并对两组疗效进行对比分析。对所有患者随访6个月及12个月。结果53例均为一次穿刺治疗成功。6个月时I组、Ⅱ组有效率分别为75．00％（18／24）和86．67％（26／30）,全部治疗总有效率为81．48％（44／54）;12个月时I组、Ⅱ组有效率分别为58．33％（14／24）和76．67％（23／30）,全部治疗总有效率为68．52％（37／54）。两组患者治疗前的囊肿平均直径和容积差异均无统计学意义,但6个月与12个月的治疗有效率差异均有统计学意义（P均do．05）。结论超声引导下经皮穿刺注入高渗葡萄糖治疗肝肾囊肿时,提高囊内葡萄糖的浓度是保证疗效的关键;且此方法操作简便,安全,尤其适宜老年患者。     

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

OBJECTIVE: To report our experience with the use of 95% ethanol as sclerotherapy for symptomatic simple renal cysts. PATIENTS AND METHODS: Sixty patients with 64 symptomatic simple renal cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of 95% ethanol (31 men and 29 women, mean age 46 years, SD 22). The main presentation was renal pain in 34 patients, renal mass in nine, hypertension in 11 and haematuria in six; 24 cysts were on the right, 32 on the left and four bilateral. Patients were evaluated after 1 month and then every 6 months by clinical assessment, US and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume with the resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume and/or persistent symptoms. RESULTS: After aspiration and ethanol sclerotherapy, there was microscopic haematuria in two patients and low-grade fever (<38.3 degrees C) in two, but no major complications. During a mean (range) follow-up of 19 (14-40) months there was complete cyst ablation in 54 cysts and partial resolution in 10. Pain disappeared or was much improved in all patients. After cyst ablation hypertension was well controlled with no medication in all 11 hypertensive patients and haematuria disappeared in all six affected patients. CONCLUSIONS: Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive and highly effective. We recommend it as the first therapeutic option in these patients.     

Adolescent varicocele: Tauber antegrade sclerotherapy versus Palomo repair

PURPOSE: There is general agreement on treatment for varicocele in pediatric patients. Randomized prospective studies have shown that anatomical and functional lesions may be corrected. Due to the impossibility of seminal examination patients with moderate to large varicocele or ipsilateral testicular hypertrophy, characterized by a change in testicular consistency or symptoms, should undergo surgical correction. The best therapeutic approach is still under discussion. MATERIALS AND METHODS: At 2 centers 2 therapeutic approaches to varicocele treatment in pediatric patients were compared, namely the Palomo repair and antegrade sclerotherapy according to Tauber. The 89 patients from the same geographical area elected 1 procedure after an explanation. From the medical records we retrospectively evaluated operative time, postoperative analgesics, postoperative fever onset, complications, convalescence, recurrence and postoperative hydrocele. RESULTS: After Palomo repair in 45 patients there were 2 recurrences (4.4%) and 2 postoperative hydroceles (4.4%). Of 44 antegrade sclerotherapy cases 1 was converted to Palomo repair, there was no hydrocele formation and recurrence developed in 2 (4.5%). Testicular atrophy was not observed in any patient regardless of the method used. The cost of the procedure was lower in the sclerotherapy group. CONCLUSIONS: These data suggest that the failure rate was similar in both groups. The principal advantages of sclerotherapy are simplicity, decreased cost and lack of hydrocele formation.     

Sclerotherapy with tetracycline solution for hydrocele

A study of sclerotherapy for hydrocele using different concentrations (10%, 5%, 2.5%) for tetracycline solution was done on 24 patients, 23 patients were cured. The effectiveness of sclerotherapy was the same for the three groups of patients with use of each different concentration of the solution. Pain was the only adverse effect. Nonspecific cellular foreign body reaction and fibrin strand proliferation were observed in the hydrocele fluid after this procedure. We consider sclerotherapy for hydrocele with tetracycline solution safe and the procedure of choice for patients in whom surgery or anesthesia is contraindicated, for patients who refuse surgery, and for economic reasons.     

Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up

Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy. Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades. The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy. Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.     

A comparison of aspiration, antazoline sclerotherapy and surgery in the treatment of hydrocele

Of 98 hydroceles (mean volume 125 ml) in a consecutive series of 92 patients, treated initially by aspiration, 14% (mean volume 70 ml) were cured. The 76 recurring hydroceles (mean volume 146 ml) were then randomised to either antazoline sclerotherapy on an out-patient basis or surgery. Cure rates were 89 and 100%, respectively, at follow-up 6 months later. Operated patients were admitted for a mean duration of 2.5 days. The results indicated that aspiration alone was inadequate, and sclerotherapy is advocated as the first choice of treatment for hydrocele.     

Aspiration and tetracycline sclerotherapy of hydrocele

Seventeen patients with hydrocele of the testis were treated by aspiration of fluid and substitution with tetracycline supplemented with 1% lidocaine. In 15 patients (88%) symptoms disappeared by sclerotherapy. After sclerotherapy scrotal ultrasonography was useful to diagnose either relapse or thickened tunica vaginalis. No side effect was noticed.     

Comparative study of sclerotherapy with phenol and surgical treatment for hydrocele

PURPOSE: We compared the efficiency, side effects and effects on spermatogenesis of sclerotherapy with phenol and surgical treatment for hydrocele. MATERIALS AND METHODS: A total of 67 patients (80 hydroceles) were randomly divided into 2 groups of 40 hydroceles each. One group underwent phenol sclerotherapy and the other underwent hydrocelectomy. Spermiograms were done before, 6 and 12 months after treatment in patients able to ejaculate. RESULTS: In the sclerotherapy group 47.5%, 30%, 12.5%, 5% and 2.5% of the hydroceles were cured with 1 to 5 injections, respectively, but 2.5% were not cured even with 6 injections. There were no complaints of localized pain or infection in these cases. All patients returned to normal activity on the same day. In the hydrocelectomy group 97.5% and 2.5% of hydroceles were cured with 1 and 2 operations, respectively. There was pain postoperatively in 73.5% of the patients and localized infection in 5%, while 62.5% required an average of 4.5 days of rest and were absent from work for 10 days. There was no significant statistical alteration in spermatozoid concentration in the preoperative, and 6 and 12-month postoperative counts in the groups (p = 0.385). CONCLUSIONS: Sclerotherapy for hydrocele with phenol is as efficacious as hydrocelectomy, while causing less morbidity and similar effects on spermatogenesis.     

Incidence and management of hydrocele following varicocele surgery in children

PURPOSE: Hydrocele seems to be the most frequent complication in children who undergo surgery for varicocele and the issue of the optimal management of hydrocele remains controversial. In this retrospective study we evaluated the incidence and management of hydrocele following surgical treatment of varicocele in children treated at 8 European centers of pediatric surgery. MATERIALS AND METHODS: In a 5-year period 278 children between 7 and 17 years old underwent surgical treatment for unilateral left varicocele, including 187 using video surgery and 91 via an open inguinal approach. RESULTS: At an average followup of 24 months (range 12 to 60) 34 children (12.2%) had a left hydrocele. Of the 278 children 14 (5%) were lost to followup. The hydrocele appeared between 1 week and 44 months (median 2 months) after surgery. Concerning hydrocele management 16 of 34 children (47%) were treated with scrotal puncture while under local anesthesia, which led to hydrocele regression after a median of 3 punctures (range 1 to 5), 12 (35.3%) underwent clinical observation since the hydrocele reduced spontaneously within a median of 12 months after its appearance and 6 (17.7%) were treated with open surgery. In 4 cases the hydrocele disappeared and in 2 it recurred after surgery and was successfully treated with punctures. CONCLUSIONS: This study shows that the median incidence of hydrocele after varicocele surgery is about 12% but it seems higher after artery nonsparing vs sparing procedures (17.6% vs 4.3%). On the contrary, no difference was found when the procedure was performed using video surgery or with the open approach. Hydroceles generally develop a few months later but may also appear several years after the surgical repair of varicocele. Noninvasive procedures (scrotal punctures or clinical observation) seem to induce total hydrocele regression in more than 82% of cases. Children who undergo surgery for varicocele should undergo long-term followup to detect a possible hydrocele. In fact, the 5.4% of children lost to followup in our study may potentially have had a hydrocele. Surgery is not always successful for this condition, as shown in the 2 cases of recurrent hydrocele after surgical repair.     

Large symptomatic Mullerian duct cyst treated by tetracycline sclerotherapy

We describe a case of large symptomatic Mullerian duct cyst in an adult treated successfully by tetracycline sclerotherapy under transrectal ultrasound imaging.     

Treatment of varicocele: a prospective randomized comparison of laparoscopy versus antegrade sclerotherapy

OBJECTIVES: To compare the therapeutic success, the morbidity and the costs of antegrade sclerotherapy versus laparoscopic varicocelectomy. METHODS: Seventy-six consecutive varicocele patients were randomly assigned to two treatment arms. Preoperative and 3 month postoperative sperm density, motility and morphology were analysed. The diagnosis of the varicocele was established clinically and with Doppler ultrasonography. RESULTS: Fifty-eight patients treated by either of the two methods were followed up. The recurrence rate increased progressively with the size of the varicocele in both groups. The postoperative incidence of complications particularly hydrocele formation was significantly higher in the laparoscopic group. The costs of the disposable material for laparoscopic varicocelectomy was twice as high as for sclerotherapy. CONCLUSIONS: Antegrade sclerotherapy is the less invasive treatment method of male varicocele with lower costs and better outcome and should therefore be the preferred treatment method for male varicocele.