title: Percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in selected patients: killing two birds with one stone?
abstract: OBJECTIVE
  To assess the safety, feasibility, and efficacy of percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in the management of a renal cyst with ipsilateral calculi in selected patients.
  
  
  METHODS
  Between July 2010 and August 2013, 16 patients (11 men and 5 women; mean age, 51 years) with a solitary posterior or parapelvic renal cyst and ipsilateral calculi underwent percutaneous intrarenal cyst marsupialization and simultaneous nephrolithotomy in our center. Mean cyst size was 6.3 cm (range, 4.2-11.8 cm). Mean stone surface area was 5.8 cm(2) (range, 1.8-12.1 cm(2)). By preoperative computed tomography planning and interoperative ultrasound guidance, the optimal puncture route was selected carefully to marsupialize the cyst and approach the target calyx. The cyst was marsupialized into the collecting system at the dilation process. Subsequently, percutaneous nephrolithotomy was performed in a standard fashion.
  
  
  RESULTS
  The mean operative time was 68 minutes (range, 47-93 minutes), and the mean hospital stay was 4 days (range, 3-7 days). A nephrostomy tube and a double-J stent were placed for a prolonged period to ensure the channel remained opened. Nearly complete cyst regression and calculi clearance confirmed by postoperative imaging was achieved in all patients. No intraoperative or postoperative complications in Clavien grading score ≥ 2 were noted during a mean follow-up of 21 months (range, 8-25 months).
  
  
  CONCLUSIONS
  In selected patients with a posterior or parapelvic renal cyst and ipsilateral calculi, the percutaneous technique is a safe and effective option through intermediate follow-up.
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Hequn
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xiongbing
authors.initials: X
authors.lastname: Zu
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Longfei
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Gynecologic Oncology, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Cao
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Zeng
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Jiping
authors.initials: J
authors.lastname: Niu
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: xyurology@gmail.com.
authors.forename: Long
authors.initials: L
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis* / Q000601:surgery*; D052177:Kidney Diseases, Cystic / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D013520:Urologic Surgical Procedures / Q000379:methods