Journal List > Korean J Urol > v.49(6) > 1005122

Choi, Seo, and Rim: Comparison of the Surgical Outcome of Laparoscopic Cyst Marsupialization for Peripheral and Parapelvic Renal Cysts

Abstract

Purpose

The location of renal cysts is related with the symptoms and signs. Parapelvic cysts are a rare form of simple renal cysts, and they are much more commonly associated with the symptoms of obstruction, pain, infection and stone formation. We evaluated the surgical outcomes of laparoscopic renal cyst marsupialization for treating the peripheral and parapelvic types of renal cysts.

Materials and Methods

Between November 1993 and April 2007, 87 patients (91 cases) who presented with symptomatic renal cysts underwent laparoscopic renal cyst marsupialization. There were 76 cases in the peripheral cyst group and 15 cases in the parapelvic cyst group. The mean age was 59.2 years (age range: 20-77) for the patients with peripheral renal cysts and 62.9 years (age range: 47-79) for the patients with parapelvic cysts.

Results

The mean operative time was 108 minutes (30-280) for the patients with peripheral renal cysts and 144 minutes (80-270) for the patients with parapelvic cysts, and there was a significant difference (p=0.031). However for the other factors, including the time for the first oral intake, the time to remove the drain and the length of the hospital stay, there were no significant differences (p=0.671, 0.088, 0.268, respectively). Complications, including bleeding and leakage, were detected in 11 patients (14.4%) of the peripheral cyst group and in 4 patients (26.6%) of the parapelvic cyst group; there was a statistical difference (p=0.035). Both groups had a high success rate, 98.7% in the peripheral cyst group and 100% in the parapelvic cyst group.

Conclusions

We found that laparoscopic renal cyst marsupialization was a standard treatment with a high success rate and a fast recovery time. However, performing this for parapelvic cysts showed a longer operative time and a higher complication rate as compared with peripheral cysts.

REFERENCES

1. Kissane JM, Smith MG. Pathology of infancy and childhood. 2nd ed.St. Louis: CV Mosby;1975. p. 587.
2. Dean AL. Treatment of solitary cyst of kidney by aspiration. Trans Am Assoc Genitourin Surg. 1939; 32:91.
3. Hulbert JC, Shepard TG, Evans RM. Laparoscopic surgery for renal cystic disease. J Urol. 1992; 147:882.
4. Seo IY, Jeong CS, Jeong HJ, Rim JS. Long term follow-up results of laparoscopic renal cyst marsupialization: comparison with alcohol sclerotherapy. Korean J Urol. 2004; 45:360–4.
5. Oh CK, Kim DW, Lee KW, Lee YS, Yang SC, Rha KH. Cost analysis of renal cyst ablation: laparoscopic cyst marsupialization versus repeated sclerotherapy about recurrent renal cyst. Korean J Urol. 2006; 47:171–4.
crossref
6. Glassberg KI. Renal dysgenesis and cystic disease of the kidney. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. editors.Campbell's urology. 8th ed.Philadelphia: Saunders;2002. p. 1964–74.
7. Amar AD, Das S. Surgical management of benign renal cysts causing obstruction of renal pelvis. Urology. 1984; 24:429–33.
crossref
8. Marumo K, Horiguchi Y, Nakagawa K, Oya M, Ohigashi T, Asakura H, et al. Incidence and growth pattern of simple cysts of the kidney in patients with asymptomatic microscopic hematuria. Int J Urol. 2003; 10:63–7.
crossref
9. Terada N, Ichioka K, Matsuta Y, Okubo K, Yoshimura K, Arai Y. The natural history of simple renal cysts. J Urol. 2002; 167:21–3.
crossref
10. Wolf JS Jr. Evaluation and management of solid and cystic renal masses. J Urol. 1998; 159:1120–33.
crossref
11. Camacho MF, Bondhus MJ, Carrion HM, Lockhart JL, Politano VA. Ureteropelvic junction obstruction resulting from percutaneous cyst puncture and intracystic isophendylate injection: an unusual complications. J Urol. 1980; 124:713–4.
12. Gauzzoni G, Montorsi F, Bergamaschi F, Consonni P, Bellin-zoni P, Centemero A, et al. Laparoscopic unroofing of simple renal cysts. Urology. 1994; 43:154–9.
crossref
13. Hoenig DM, Leveillee RJ, Amaral JF, Stein BS. Laparoscopic unroofing of symptomatic renal cysts: three distinct surgical approaches. J Endourol. 1995; 9:55–8.
crossref
14. Camargo AH, Cooperberg MR, Ershoff BD, Rubenstein JN, Meng MV, Stoller ML. Laparoscopic management of peripelvic renal cysts: University of California, San Francisco, experience and review of literature. Urology. 2005; 65:882–7.
crossref
15. Chun SJ, So YS, Kim CS. Retroperitoneal laparoscopic ablation of peripelvic renal cyst. Korean J Urol. 2002; 43:662–6.
16. Yoder BM, Wolf JS Jr. Longterm outcome of laparoscopic decortication of peripheral and peripelvic renal and adrenal cysts. J Urol. 2004; 171:583–7.
crossref

Fig. 1.
Abdominopelvic computed tomography shows a 4.7cm-sized right parapelvic cyst (arrow). It compresses the right renal pelvis and it may have caused the renal stones at the lower calyx.
kju-49-497f1.tif
Fig. 2.
Abdominopelvic computed tomography shows a 10.4cm-sized right peripheral cyst (arrow).
kju-49-497f2.tif
Table 1.
The baseline characteristics of the patients in each groups
  Peripheral cyst Parapelvic cyst
No. of cases (No. of patients) 76 (73) 15 (14)
Mean age (years) 59.2 (20-77) 62.9 (47-79)
Sex ratio (male:female) 1:1.5 1:1.3
Laterality (right/left/bilateral, %) 30/43/3 6/8/1
  (39.4/56.5/3.9) (40/53.3/6.6)
Mean cyst size (cm) 6.07 (1.3-15.0) 5.84 (3.7-9.0)
Hematuria (%) 27 (35.5) 7 (46.5)
Cyst location (%)
Upper pole 11 (14.4) 4 (26.6)
Mid pole 49 (64.4) 8 (53.3)
Lower pole 16 (21.0) 3 (20.0)
Mean follow up duration (months) 6.6 (3-84) 10.2 (3-72)
Table 2.
Comparison of the perioperative and follow-up data
  Peripheral cyst Parapelvic cyst p-value
Mean operative time (min) 108.0 (30-280) 144.0 (80-270) 0.031
Mean first oral intake time (days) 1.27 (1-4) 1.21 (1-2) 0.671
Mean drainage removal time (days) 4.5 (1-19) 5.9 (2-14) 0.088
Mean hospital stay (days) 7.5 (3-28) 8.8 (5-17) 0.268
Mean follow up duration (months) 6.6 (3-84) 10.2 (3-72) 0.612
Complications (%) 11 (14.4) 4 (26.6) 0.035
Bleeding (%) 9 (11.8) 2 (13.3) 0.780
Transfusion (units) 2.5 (1-7) 5 (2-8) 0.840
Leakage (%) 2 (2.6) 2 (13.3) 0.059
Outcomes (%)
Complete remission 66 (86.8) 14 (93.3) 0.481
Partial remission 9 (11.8) 1 (6.6) 0.567
Recurrence 1 (1.3) 0 0.660
Mean analgesic use (diclofenac, mg) 60.4 (0-450) 54.6 (0-270) 0.963
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