A new treatment of simple renal cyst: percutaneous instillation of minocycline hydrochloride into simple renal cyst

Minocycline hydrochloride was percutaneously instilled into simple renal cysts to prevent recurrence of renal cysts after the puncture and aspiration of cystic fluid. Fifty-six simple renal cysts in 51 patients were punctured with an 18-gauge needle under ultrasonographic guidance, and the cystic fluid was aspirated under fluoroscopic control. A single 100 mg or 200 mg dose of minocycline hydrochloride dissolved in 5 ml of distilled water was instilled through the needle into the renal cyst. The patients were followed up by computed tomographic (CT) scan and ultrasonography 1, 3, 6 and 12 months after the treatment. Efficacy was evaluated after 3 months or longer. Of 20 renal cysts instilled with 100 mg of minocycline, efficacy was excellent in 10, good in 6 and poor in 4. Of 22 renal cysts instilled with 200 mg of minocycline, efficacy was excellent in 10, good in 9 and poor in 3. No significant difference was noted between the efficacy rate of 100 mg and 200 mg treatments. Complications attributable to treatment were observed in 15 patients: moderate pain in one, slight pain in 6, slight fever in 8 and slight hematuria in one. Neither severe adverse reactions nor infections were observed in any of the patients. These results suggest that the percutaneous instillation of minocycline into simple renal cysts is a new, simple, safe and effective treatment to prevent recurrence of the cyst and additionally to prevent infection following the puncture.     

单纯性肾囊肿的治疗(附121例分析)

目的总结单纯性肾囊肿的治疗经验。方法回顾性分析了121例单纯性肾囊肿患者的临床资料,其中69例行经皮囊肿穿刺抽液无水酒精注射法,33例行开放手术(其中22例行小切口肾囊肿去顶减压术),19例行腹腔镜肾囊肿去顶减压术。总结不同方法的治疗效果。结果各组均取得满意的治疗效果,并发症发生率低。穿刺组住院费用低,小切口手术组在治疗效果和住院费用上有优势。结论不同的治疗方法各有优缺点,根据患者的情况选择治疗方法能够取得满意的效果。     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿的初步体会

目的：总结经腹膜后腹腔镜囊肿去顶术治疗单纯性肾囊肿的经验，讨论手术适应证和手术要点，方法：采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿患者32例，结果：31例手术成功，1例转为开放手术，微小并发症发生率为16％，技术熟练后无并发症发生，1例术后3个月复发，术后平均住院3天，结论：经腹膜后腹腔镜囊肿去顶术创伤小，患者康复快，宜为肾囊肿外科治疗的首选术式。     

单纯性肾囊肿的个体化治疗方案探讨

目的根据肾囊肿的部位个体化选择治疗方案,以提高单纯性肾囊肿的外科治疗效果。方法回顾性分析398例单纯性肾囊肿患者的临床资料,分析患者全身情况、囊肿位置及囊肿大小等特点与成功治疗肾囊肿的相关性。结果接受经皮穿刺引流并反复注射无水乙醇或联合生物蛋白胶的患者225例,接受经腹腔镜肾囊肿去顶减压术联合生物蛋白胶治疗的患者158例,接受输尿管镜下内切开引流术者15例。其中有效率99.5%,治愈率94.0%,无其他脏器损伤、感染性休克、化学性肾盂肾炎等严重并发症。结论单纯性肾囊肿患者应根据肾囊肿部位、个体化选择治疗方法。     

Laparoscopic resection of a simple renal cyst

Laparoscopic dissection of common renal cysts was made in 27 patients who complained of low back pains and hypertension. The diagnosis and indications for operation rested on ultrasonic investigation and dynamic nephroscintigraphy. All the surgical interventions were performed under endotracheal anesthesia after creation of pneumoperitoneum with the use of three trochars. The procedure comprised maximal dissection of the free cystic wall, electrocoagulation of the residual part's margins and retroperitoneal drainage. Postoperative period was uneventful in 92.6% of the cases. Control examination 3 and 6 months after the operation indicated good results: pain relief, stabilization of arterial pressure and improvement of renal function.     

Papillary carcinoma in wall of simple renal cyst

The second case of microscopic focal papillary carcinoma discovered in the wall ofsimple serous renal cyst, which showed negative results on cytologic examination, is presented. This lesion would have remained undiagnosed except for surgery. A modification of the accepted classification of coexistent renal tumor and cyst is proposed on the basis of histologic findings.     

A simple renal cyst invaded by infiltrating urothelial carcinoma mimicking a Bosniak Class IV renal cyst

We report a 79-year-old woman with a left side simple renal cyst invaded by infiltrating urothelial carcinoma mimicking a Bosniak Class IV renal cyst. Computerized tomography has high accuracy for the diagnosis of renal cysts and urothelail carcinoma. But, in this case it was still difficult to distinguish a simple renal cyst with infiltrating urothelial carcinoma invasion from a Bosniak Class IV renal cyst on CT scan. The management of a Bosniak Class IV renal cyst and urothelail carcinoma is totally different. Therefore, we performed a left side nephroureterectomy. This patient will have regular follow-up with cystoscopy every 3 months for the first 2 y, every 6 months for the next 2 y, and then annually thereafter.     

Huge renal arteriovenous malformation mimicking a simple para-pelvic cyst

The presenting symptoms of renal arteriovenous malformation are usually gross hematuria and hypertension. Herein we present an unusual case of a huge renal arteriovenous malformation without these signs, but with an ultrasound picture mimicking a simple para-pelvic cyst. Other imaging tests, including duplex ultrasound, computerized tomography and aortography, demonstrated the vascular lesion. We suggest that duplex ultrasound should accompany routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests an intra-abdominal vascular lesion or bleeding.     

Hypernephroma arising in wall of simple renal cyst.

An unusual case of hypernephroma arising from the wall of a simple renal cyst is presented. Despite prior controversy as to the existence of this entity continuity between normal and neoplastic cells lining the cyst wall was demonstrated thus confirming this lesion as a distinct entity. Furthermore, we wish to direct attention to the limitations of biochemical and cytologic analysis of renal cyst fluid in distinguishing benign and neoplastic lesions.     

Sonographically detected malignant transformation of a simple renal cyst

The clinical course is reported of a simple renal cyst which developed into a septated renal cyst, and finally to a cystic renal cell carcinoma. A 49-year-old man, who had been diagnosed as having a renal cyst, was found by repeated ultrasonography over 6 years to have solid components developing within the cyst. Radical nephrectomy was performed, and pathological examination confirmed cystic renal cell carcinoma (RCC). This case clearly shows a natural history of malignant transformation from a simple renal cyst, and emphasizes that careful follow-up of renal cysts, especially of complicated renal cysts, is mandatory for successful treatment of RCC.     

Isolated unilocular renal hydatid cyst: a rare diagnostic difficulty with simple cyst

Hydatid disease is endemic in many parts of the world. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% of the cysts occur in the rest of the body. It may develop in almost any part of the body. Although hydatidosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except for eosinophilia which is found in only 50% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain radiography or intravenous urography, and ultrasound or computed tomography cannot always show a hydatidosis as a specific lesion. From these reasons, sometimes it is difficult to differentiate between a unilocular hydatid cyst without mural calcification and a simple renal cyst. So, despite its rarity, hydatid disease should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We present herein a patient with isolated renal hydatid cyst mimicking a simple cyst treated successfully with complete excision.     

A case of small simple renal cyst associated with renal cell carcinoma

A 61-year-old male was admitted to our clinic for the purpose of further examination of the small renal mass discovered incidentally by ultrasonography. Subtraction angiography disclosed a small renal cell carcinoma of the upper-lateral margin of the left kidney dramatically. Enucleating surgery of the tumor was performed successfully (about 2 cm in diameter). Histological examination revealed a small simple renal cyst associated with renal cell carcinoma. The patient is well without evident metastasis 1 year postoperatively. Since this is a very rare case in the literature, we report this case and discuss the preoperative diagnosis of small renal cell carcinoma. We believe that ultrasonography is a simple and very useful method for mass screening of small urological malignancies.     

A retroperitoneal gastric duplication cyst mimicking a simple exophytic renal cyst in an adolescent

Gastric duplications are rare anomalies and usually occur along the greater curvature of the stomach. The authors herein describe an uncommon case of a retroperitoneal gastric duplication, which was not found during previous emergency laparotomy for suspected peritonitis at another institution. On subsequent computed tomography scan, the lesion was misinterpreted as a simple exophytic renal cyst. Laparoscopy was undertaken because of unresolved symptoms, and a retroperitoneal duplication cyst was successfully excised. It was lined with gastric mucosa and islands of pancreatic tissue on pathologic examination.     

Mucinous cystadenoma mimicking simple renal parenchymal cyst in a horseshoe kidney

We report a case of mucinous cystadenoma in a horseshoe kidney which radiologically resembled a simple renal cyst. In the published literature, three cases of mucinous cystadenoma of renal origin have been reported. Although these tumors are believed to originate from the renal pelvis, the cyst in the present case originated from renal parenchyma. The significance of this particular case is the radiological features, which mimic a simple renal parenchymal cyst and contribute to the histopathological definition of an extremely rare disease.     

Case report: endoscopic unroofing of symptomatic peripelvic simple renal cyst

We report the ureteroscopic unroofing of a symptomatic peripelvic cyst with a holmium laser in a 37-year-old woman. At 1-year follow-up, the patient remains symptom free. Endoscopic management of peripelvic cysts is durable and can be performed safely.     

Increased risk of kidney damage among Chinese adults with simple renal cyst

Background

The presence of simple renal cyst (SRC) has been related to hypertension, the early and long-term allograft function, and aortic disease, but the relationship with kidney damage was still controversial. Accordingly, we conducted a large sample cross-sectional study to explore the association of SRC with indicators of kidney damage among Chinese adults.

Methods

A total of 42,369 adults (aged 45.8?±?13.67 years, 70.6% males) who visited the Health Checkup Clinic were consecutively enrolled. SRC was assessed by ultrasonography according to Bosniak category. Multiple regression models were applied to explore the relationships between SRC and indicators of kidney damage [proteinuria (dipstick urine protein?≥?1+) and decreased estimated glomerular filtration rate (DeGFR)?<?60 ml/min/1.73 m²].

Results

Among all participants in the study, the prevalence of SRC was 10.5%. As a categorical outcome, participants with more 1 cyst and with 1 cyst had higher percentage of proteinuria [53 (5.3%) and 93 (2.7%) vs. 596 (1.6%), p?<?0.001] and DeGFR [57 (5.7%) and 85 (2.5%) vs. 278 (0.7%), p?<?0.001] compared with participants with no cyst. SRC significantly correlated with proteinuria [OR 1.59 (95% CI 1.30–1.95)] and DeGFR [OR 1.97 (95% CI 1.56–2.47)] after adjusting for potential confounders. Furthermore, the results also demonstrated that maximum diameter (per 1 cm increase), bilateral location, and multiple cysts significantly correlated with DeGFR in the multiple logistic regression analysis.

Conclusions

The study revealed that SRC significantly correlated with kidney damage and special attention should be paid among Chinese adults with SRC.