Long-term outcome after flexible ureteroscopy with holmium laser for simultaneous treatment of a single renal cyst and ipsilateral renal stones

Abstract

Objective To assess the long-term outcome of simultaneous treatment of a single renal cyst and ipsilateral stones with transurethral flexible ureteroscopy (FURS) lithotripsy and internal cyst drainage. Methods Patients who underwent simultaneous treatment with FURS lithotripsy and internal cyst drainage in our institution between July 2014 and September 2017 were enrolled. The cyst wall was identified endoscopically and a 1–3-cm window was created in the wall using a holmium laser. The proximal end of a double-J stent was placed in the cystic cavity to facilitate internal drainage. Results Thirteen patients underwent simultaneous treatment. No intraoperative complications with Clavien grading score >2 were noted in any patients. Mean stone burden and cyst diameter were 1.6 (range: 0.9–2.5) cm and 5.8 (range: 3.0–7.1) cm, respectively. Stone-free rates after single and complementary procedures were 84.6% and 92.3%, respectively. During the mean 33.1-month follow-up period (range: 17–54 months), seven patients (53.8%) achieved full resolution of renal cysts, five patients (38.5%) maintained >50% size reduction, and one patient (7.6%) experienced recurrence at 18 months postoperatively. Conclusions FURS with a holmium laser may constitute a safe and effective alternative procedure for simultaneous treatment of a single renal cyst and ipsilateral stones.

Clinical efficacy of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts

“…If a small amount of uncontrolled hemorrhage is found under microscope, for example, holmium laser can be used for hemostasis; after fenestration during operation, the blending phenomenon between the cystic fluid and the transparent saline that is used to wash the flexible ureteroscopes visual field can be observed until the cystic fluid and the washed-down fluid are completely fused due to the fact that the cystic fluid is not completely transparent, most of which is usually pale-yellow. After fenestration, one end of the double-J tube is put into the cyst cavity [ 27 ]. One the one hand, the recurrence of the cyst after operation can be avoided; on the other hand, it is helpful to drain the cyst fluid.…”

Retrograde intrarenal surgery: Past, present, and future

“…In addition, for patients with multifocal <3-cm UTUC with low-grade pathological findings and no invasive aspect on computed tomography urography, retrograde endourological procedures might become a more common treatment. Furthermore, novel laser systems might help to manage postoperative ureteral stricture, symptomatic renal cysts, and recurrent ureteropelvic junction stenosis [ 85 86 ].…”

Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts

“…It is difficult to discern with the naked eye that suspicious lesions are simply renal cysts, and studies have shown that the presence of a simple renal cyst increases the risk of infection, bleeding, and conversion into malignancy in the long-term ( 5 ). Unroofing these cysts adds an increased risk of urinary leak if connected with the collecting system ( 6 , 7 ). Renal tumors such as renal cell carcinoma (RCC) were identified in 5 of 553 deceased donor kidneys (0.9%) at the time of organ recovery ( 8 ).…”