Journal List > Korean J Urol > v.49(10) > 1005205

Park, Ham, Kim, Lee, Cho, Cho, and Choi: Treatment of Simple Renal Cysts by Percutaneous Aspiration and OK-432 Sclerotherapy

Abstract

Purpose

Percutaneous aspiration with sclerotherapy has been widely used for the treatment of symptomatic or large simple renal cysts. Ethanol has been most commonly used as a sclerosing agent; however, a temporary percutaneous nephrostomy for multiple ethanol injections is necessary to achieve a low recurrence rate. Thus, we used OK-432 as a new sclerosing agent without a temporary percutaneous nephrostomy for multiple injections, and also compared our results with the results of previous studies.

Materials and Methods

Between October 2005 and April 2006, 50 patients (63 simple renal cysts) who underwent percutaneous OK-432 sclerotherapy for simple renal cysts were evaluated. The simple renal cysts were aspirated under ultrasonography and fluoroscopy, after which OK-432 was injected into the cyst. Follow-up was performed with ultrasonography or CT scan after 3 months. Regression of the renal cyst or a >70% reduction in size with no symptoms was considered a treatment success.

Results

Among 63 renal cysts in 50 patients, complete regression occurred in 17 (27.0%). Greater than a 90% reduction in size occurred in 8 (12.7%), a 80–90% reduction in size occurred in 21 (33.3%), and a 70–80% reduction in size occurred in 15 (23.8%); a <70% reduction in size occurred in 2 (3%). The overall efficacies of success were 96.8%. After the procedure, there were only some minor complications, such as mild fever, local pain, and liver function test elevation that subsided with symptomatic treatment.

Conclusions

Percutaneous OK-432 sclerotherapy is simple, safe, and effective and can be an alternative first-line therapy of simple renal cysts.

References

1. 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
2. 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
3. Raskin MM, Poole DO, Roen SA, Viamonte M Jr. Percutaneous management of renal cysts: results of a four-year study. Radiology. 1975; 115:551–3.
crossref
4. Bean WJ. Renal cysts: treatment with alcohol. Radiology. 1981; 138:329–31.
crossref
5. Brown B, Sharifi R, Lee M. Ethanolamine sclerotherapy of a renal cyst. J Urol. 1995; 153:385–6.
crossref
6. Holmberg G, Hietala SO. Treatment of simple renal cysts by percutaneous puncture and instillation of bismuth-phosphate. Scand J Urol Nephrol. 1989; 23:207–12.
crossref
7. Ohkawa M, Tokunaga S, Orito M, Shimamura M, Hirano S, Okasho A, et al. Percutaneous injection sclerotherapy with minocycline hydrochloride for simple renal cysts. Int Urol Nephrol. 1993; 25:37–43.
crossref
8. Paananen I, Hellström P, Leinonen S, Merikanto J, PeräläJ , Päivänsalo M, et al. Treatment of renal cysts with single-session percutaneous drainage and ethanol sclerotherapy: longterm outcome. Urology. 2001; 57:30–3.
crossref
9. Phelan M, Zajko A, Hrebinko RL. Preliminary results of percutaneous treatment of renal cysts with povidone-iodine sclerosis. Urology. 1999; 53:816–7.
crossref
10. Seo TS, Oh JH, Yoon Y, Lim JW, Park SJ, Chang SG, et al. Acetic acid as a sclerosing agent for renal cysts: comparison with ethanol in follow-up results. Cardiovasc Intervent Radiol. 2000; 23:177–81.
crossref
11. Touloupidis S, Fatles G, Rombis V, Papathanasiou A, Balaxis E. Percutaneous drainage of simple cysts of the kidney: a new method. Urol Int. 2004; 73:169–72.
crossref
12. Lee CB, Lee JH, Jang H, Lee KB, Ha US, Cho DH. The efficacy of repeated sclerotherapy after percutaneous aspiration of the simple renal cyst. Korean J Urol. 2006; 47:252–6.
crossref
13. Ok YC, Jung GW, Kang TW, Gil MC, Hwang JS, Kim DH, et al. Percutaneous sclerotherapy of simple renal cyst using minocycline HCl. Korean J Urol. 2001; 42:471–5.
14. Fontana D, Porpiglia F, Morra I, Destefanis P. Treatment of simple renal cysts by percutaneous drainage with three repeated alcohol injection. Urology. 1999; 53:904–7.
15. Ogita S, Tsuto T, Deguchi E, Tokiwa K, Nagashima M, Iwai N. OK-432 therapy for unresectable lymphangiomas in children. J Pediatr Surg. 1991; 26:263–8.
crossref
16. Ogita S, Tsuto T, Nakamura K, Deguchi E, Iwai N. OK-432 therapy in 64 patients with lymphangioma. J Pediatr Surg. 1994; 29:784–5.
crossref
17. Ogita S, Tsuto T, Tokiwa K, Takahashi T. Intracystic injection of OK-432: a new sclerosing therapy for cystic hygroma in children. Br J Surg. 1987; 74:690–1.
crossref
18. Kim JH, Lee JT, Kim EK, Won JY, Kim MJ, Lee JD, et al. Percutaneous sclerotherapy of renal cysts with a beta-emitting radionuclide, holmium-166-chitosan complex. Korean J Radiol. 2004; 5:128–33.
crossref
19. De Dominicis C, Ciccariello M, Peris F, Di Crosta G, Sciobica F, ZuccalàA , et al. Percutaneous sclerotization of simple renal cysts with 95% ethanol followed by 24–48 h drainage with nephrostomy tube. Urol Int. 2001; 66:18–21.
crossref
20. Delakas D, Karyotis I, Loumbakis P, Daskalopoulos G, Charoulakis N, Cranidis A. Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts. Int Urol Nephrol. 2001; 32:321–6.
21. Falci-Júnior R, Lucon AM, Cerri LM, Danilovic A, Da Rocha PC, Arap S. Treatment of simple renal cysts with single-session percutaneous ethanol sclerotherapy without drainage of the sclerosing agent. J Endourol. 2005; 19:834–8.
crossref
22. Hanna RM, Dahniya MH. Aspiration and sclerotherapy of symptomatic simple renal cysts: value of two injections of a sclerosing agent. AJR Am J Roentgenol. 1996; 167:781–3.
crossref
23. Jeong BY, Kim JI, Park SS. Effect of sclerotherapy after percutaneous aspiration of the simple renal cyst. Korean J Urol. 2005; 46:74–9.
24. Chung BH, Kim JH, Hong CH, Yang SC, Lee MS. Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst. BJU Int. 2000; 85:626–7.
crossref

Fig. 1.
(A) Bilateral simple renal cysts on the lower pole of the right kidney (3.8cm) and the upper pole of the left kidney (6.0cm) in a CT coronal view. (B) Collapsed previous renal cyst after bilateral OK-432 (Picibanil) sclerosing therapy in a CT coronal view.
kju-49-917f1.tif
Table 1.
Characteristics of patients and cysts
  No. of case
No. of patients 50
Age (years) 63.8 (47–76)
Sex ratio (male/female) 17/33
No. of renal cysts 63
Laterality (right/left) 39/24
Location  
Upper 29
Mid 15
Lower 19
Cyst size (cm)  
<7 36
7–10 20
≥10 7
Mean size (cm) 7.1 (4.8–13.0)
Cyst volume (ml)  
<200 37
200–500 19
≥500 7
Mean volume (ml) 220.98 (57.9–1,149.8)
Mean follow up (weeks) 14.9 (12–18)
Table 2.
Characteristics of treatment and follow-up
  Renal cyst no.
Renal cyst size follow up  
Trace (%) 17 (27.0)
<10 (%) 8 (12.7)
10–20 (%) 21 (33.3)
20–30 (%) 15 (23.8)
Overall success treatment (%) 61 (96.8)
Failure treatment (%) 2 (3.0)
Complication (%)  
Mild fever (%) 4∗ (8.0)
Flank pain (%) 12∗ (24.0)
Elevated liver enzyme (%) 4∗ (8.0)
Examination of cystic fluid  
Biochemical profile All normal
Cytologic studies All negative

: No. of patients

Table 3.
Reported success rates following single sclerotherapy vs. serial sclerotherapies
  Single sclerotherapy Repeated sclerotherapy
Chung et al24 Jeong et al23 Ours Chung et al24 Jeong et al23 Lee et al12
No. of patients 42 18 50 40 10 39
Success rate            
Complete (%) 19 39 27.0 72.5 60 61.5
Partial (%) 38∗ 55.5∗ 69.8 22.5∗ 30∗ 33.3∗
Total (%) 57 94.5 96.8 95 90 94.8

The relief of symptoms with a reduction in the diameter of the cyst by more than half,

The relief of symptoms with a reduction in the diameter of the cyst by more than 70%

TOOLS
Similar articles