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.
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.
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.
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.
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.
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.
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.
9. Phelan M, Zajko A, Hrebinko RL. Preliminary results of percutaneous treatment of renal cysts with povidone-iodine sclerosis. Urology. 1999; 53:816–7.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Table 1.
Table 2.
Table 3.
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 |