title: Surgical cyst decortication in autosomal dominant polycystic kidney disease.
abstract: OBJECTIVE
  To provide a summary of the relevant literature regarding the impact of surgical cyst decortication on hypertension, renal function, and pain management in patients with autosomal dominant polycystic kidney disease (ADPKD).
  
  
  METHODS
  Data collection was conducted via a Medline search using the subject headings autosomal dominant polycystic kidney disease, surgery, decortication, and marsupialization. Additional reports were derived from references included within these articles.
  
  
  RESULTS
  Despite a trend for improved blood pressure control after cyst decortication in some studies, this cumulative review of the literature did not provide consistent evidence supporting the role of this procedure in blood pressure management in patients with ADPKD. Surgical cyst decortication was associated with renal deterioration in a subset of patients with compromised baseline renal function but did not otherwise appear to have a significant impact on renal function in the majority of studies reviewed. Improvement in chronic pain after this procedure was ubiquitously reported across all studies examined.
  
  
  CONCLUSIONS
  Despite a potential role in blood pressure management in the setting of ADPKD, surgical cyst decortication has not been definitively shown to alleviate hypertension in this clinical setting. Renal function does not appear to improve following this surgery. Patients with compromised baseline renal function appear to be at increased risk for further deterioration in renal function after cyst decortication, although the role of this procedure in altering the natural trajectory of renal failure in this patient subset needs further investigation. Cyst decortication is highly effective in the management of disease-related chronic pain for the majority of patients with ADPKD, providing durable pain relief in this patient population.
authors.affiliation: Saint Louis University School of Medicine, 4960 Children’s Place, Saint Louis, MO 63110, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Millar
authors.forename: Youssef S
authors.initials: YS
authors.lastname: Tanagho
authors.forename: Mohammed
authors.initials: M
authors.lastname: Haseebuddin
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: R Sherburne
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D006498:Hepatectomy / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery; D010146:Pain / Q000209:etiology / Q000601:surgery; D059408:Pain Management; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000601:surgery*