Percutaneous endocystolysis, a safe and minimally invasive treatment for renal cysts: a 13-year experience.
OBJECTIVE
Renal cysts are the most common form of renal mass with a prevalence of 35% in people older than 50 years. Several techniques are used to manage symptomatics cysts, from sclerotherapy to open surgery. We present a safe and minimally invasive therapeutic alternative: Percutaneous endocystolysis (PE).


METHODS
Between 1995 and 2008, 32 patients were treated for large symptomatic Bosniak type I and II renal cysts with the PE technique. Percutaneous access was obtained by direct puncture guided by fluoroscopy or ultrasonography, percutaneous dilation, and placement of a 28F Amplatz sheath; then a 26F resectoscope with a rollerball electrode was introduced into the interior of the cyst and the whole internal surface was inspected and cauterized. After cauterization, a 20F Foley catheter was placed inside the cyst. Patients were discharged the next day, and the catheter was removed in the outpatient facility after 7 to 10 postoperative days. The variables of age, cyst volume, operative time, and length of hospital stay were statistically analyzed using the Pearson linear correlation coefficient.


RESULTS
Clinical follow-up ranged from 4 to 162 months (mean 76 mos). Percutaneous access to the cyst was obtained by blind puncture in 7 (21.8%) patients, aided by fluoroscopy in 12 (37.5%) patients, and guided by ultrasonography in 13 (40.7%) patients. Clinical improvement was observed in all patients with a success rate of 100%. The length of hospital stay was 21.7 ± 8.5 hours (range 9-48 h). The operative time was 41.8 ± 19.7 minutes (range 12-94 min). There was a low complication rate associated with the transparenchymatous PE procedure.


CONCLUSIONS
PE is a safe, minimally invasive, and effective technique for the management of large symptomatic renal cysts and is associated with high success rates and low complication rates in long-term follow-up.
Busato
Wilson F S
WF
Departments of Urology and Experimental Surgery, UNIVALI (University of Itajai Valley), and INCAU (Catarinense's Urological Institute), Itajai, Santa Catarina, Brazil. wbusato@univali.br
Bettega
Luciano B
LB
D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult