title: Retroperitoneoscopic management of infected cysts in adult polycystic kidney disease.
abstract: Conservative measures are the mainstay of therapy in adult polycystic kidney disease (APKD). Pain, infection and obstructive uropathy are the major indications for intervention. Chronic pain has been treated with narcotic analgesics, needle aspiration of dominant cysts, and open renal cyst decortication. Laparoscopic cyst decortication, by either transperitoneal or retroperitoneal access, is a new emerging option with similar efficacy to open surgery and less morbidity. Cyst infection in these patients responds poorly to commonly used antibiotics. Patients with refractory cyst infection may even require nephrectomy. Herein, we present 2 cases with APKD that were treated by retroperitoneoscopic decortication for painful and infected cysts. Both patients showed prompt and sustained improvement in symptoms, with minimal morbidity and short convalescence. This approach has not hitherto been described for infected cysts in APKD. The retroperitoneoscopic route should be preferred in the presence of infected cysts so as to prevent intraperitoneal contamination.
authors.affiliation: Department of Urology, All-India Institute of Medical Sciences, New Delhi, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Hemal
authors.forename: N P
authors.initials: NP
authors.lastname: Gupta
authors.forename: T P
authors.initials: TP
authors.lastname: Rajeev
authors.forename: M
authors.initials: M
authors.lastname: Aron
authors.forename: D
authors.initials: D
authors.lastname: Bhowmik
authors.forename: R
authors.initials: R
authors.lastname: Jain
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D007690:Polycystic Kidney Diseases / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D012187:Retroperitoneal Space; D013396:Suction; D014057:Tomography, X-Ray Computed