The Effect of Two-Injection Ethanol Sclerotherapy with 5-Minute Duration of Exposure Time in Simple Renal Cysts

Seung Eun Lee; Jae Ho Cho

doi:10.3348/jksr.2017.77.2.113

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Lee and Cho: The Effect of Two-Injection Ethanol Sclerotherapy with 5-Minute Duration of Exposure Time in Simple Renal Cysts

Original Article

J Korean Soc Radiol 2017;77(2):113-120.

Published online: 19 January 2017

DOI: https://doi.org/10.3348/jksr.2017.77.2.113

The Effect of Two-Injection Ethanol Sclerotherapy with 5-Minute Duration of Exposure Time in Simple Renal Cysts

Seung Eun Lee, MD, Jae Ho Cho, MD^*,

Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea

^*Corresponding author: Jae Ho Cho, MD Department of Radiology, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel. 82-53-620-3043 Fax. 82-53-653-5484 E-mail: jhcho@yu.ac.kr

Received 11 November 20168 January 2017 Accepted 7 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the results of two-injection ethanol sclerotherapy in simple renal cysts performed with 5-minute ethanol exposure time.

Materials and Methods

We retrospectively reviewed 30 renal cysts in 30 patients treated by ethanol sclerotherapy between November 2002 and October 2015. Under ultrasound guidance, the renal cyst was punctured and a 7 Fr pigtail catheter was in-serted, and then complete aspiration of the cystic fluid was performed. Then, 99.9% ethanol in a quantity amounting to 1/3–1/2 of the aspirated volume was infused into the cyst and it was immediately removed. The same amount of ethanol was re-infused and removed after 5 minutes. Follow-up examination was performed using ultra-sound or CT images at least 3 months after the procedure and pre- and post-treat-ment cyst volumes were estimated. The therapeutic response was classified as either complete success (volume reduction, ≥ 95%), partial success (volume reduction, 50–95%), or failure (volume reduction, < 50%) based on the volume reduction rate.

Results

The average volume reduction rate was 96.3%. The rates of complete suc-cess, partial success and failure were 80% (n = 24), 20% (n = 6), and 0% (n = 0), re-spectively. There was no complication except for minor flank pain.

Conclusion

Two-injection ethanol sclerotherapy with 5-minute exposure time rep-resents a simple and effective treatment for simple renal cysts.

Keywords: Sclerotherapy, Ethanol, Kidney Disease, Cystic

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Fig. 1.

A representative case of complete success in a 58-year-old woman. A. Pre-procedural contrast enhanced axial CT image shows a simple renal cyst with a volume of 449.78 mL (10 × 8.6 × 10 cm) in the right kidney. B, C. The renal cyst is punctured under ultrasound guidance (B) and a cystogram (C) shows neither extravasation of the contrast material nor a connection with the collecting system. D. At the 6-month follow-up, contrast enhanced axial CT image shows the remaining cyst with a volume of 3.14 mL (2.2 × 1.3 × 2.1 cm). Volume reduction rate is 99.3%.

Fig. 2.

A representative case of partial success in a 56-year-old man. A. Pre-procedural contrast enhanced axial CT image shows a simple renal cyst with a volume of 234.3 mL (8 × 7 × 8 cm) in the left kidney. B. A 7Fr pigtail catheter is inserted into the renal cyst and a cystogram is obtained. C. At the 6-month follow-up, US image shows the remaining cyst with a volume of 41.49 mL (4.5 × 4.1 × 4.3 cm). Volume reduction rate is 82.3%.

Table 1.

Variable Techiques of Ethanol Sclerotherapy on Simple Renal Cysts as Reported by Different Authors

Ref. No.	Cysts/ Patients	Repeat Injection	Ethanol Concentration	Ethanol Exposure Time (Minutes)	Ethanol Volume/ Cyst Volume	Maxinum Ethanol Volume (mL)	Position Change	Response Rate
3	17/14(	8(within 5 days)	95%	90	15%	U	Y	CS: 14/17 PS (< 2 cm): 3/17
9	32/32	1–3(same session)	99%	20-60	25%	100	Y	CS: 22% Symptom relief: 87%
10	(64/60	1–3(24 hr interval)	95%	20-60	25%	150	Y	CS: 84% PS: 16%
11	(52/46	1–2(48 hr interval)	95%	20-40	25%	U	Y	-
								AVRR: 93%
12	98/97	1	95%	20	30–40%	200	Y	CS: 17.5%
								Symptom relief: 83%
13	27/27(	1–5 (24 hr interval)	95%	20-100	20–30%	100	Y	CS: 41% PS: 59%
	20/20	1	95%	120	30–50%	100		CS: 40% PS: 60% CS: 71%
14	252/252	1–2(1 hr interval)	pure	20-40	20 mL	-	U	PS: 22% F: 7%
15	10/10(	1–3(24 hr interval)	95%	20-60	25–40%	250	Y	CR: 70% PR: 30%
30	22/21	1	95%	120	30–50%	150	Y	AVRR: 97.3%
30	14/12	1	95%	240	30–50%	150	Y	AVRR: 97.9%
								CS: 33%
31	30/30	1	96%	120	30–40%	100	Y	PS: 47%
								F: 20%
Present study	30/30(rep	2 peat immediately	)99.9%	5	33–50%	100(except 8 cases)	) N	CS: 80% PS: 20% AVRR: 96.3%

AVRR = average volume reduction rate, CS = complete success, F = failure, N = no, PS = partial success, Ref. No. = reference number, U = unknown, Y = yes

Table 2.

Characteristics of Patients and Renal Cysts

Variable	Value
Patient characteristics
Age (year)
Mean	63.7
Range	24–83
Sex (no. of patients)
Male	9
Female	21
Clinical presentation
Flank discomfort or palpable mass	18
Hematuria	4
Asymptomatic, but increased in size	8
Renal cyst characteristics
Laterality
Right	13
Left	17
Location
Upper	11
Mid	5
Lower	14
Size (cm)
Mean	8.2
Range	4.3–12
Aspirated volume (mL)
Mean	273.8
Range	40–800
Calculated volume (mL)
Pre-sclerotherapy
Mean	264
Range	45.8–861.3
Post-sclerotherapy
Mean	7.5
Range	0–61.4

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