Non-Operative Management of a Pelvic Hydatid Cyst Communicating with the Bladder

Abstract

Two cases are reported of spontaneous rupture of pelvic hydatid cysts into the bladder, which were managed conservatively. The resulting communication between the bladder and the cyst was used advantageously for intravesical instillation of 20% saline to destroy the germinal layer of the hydatid cyst and daughter cysts. Sequential cystographic studies showed disappearance of the extrinsic pressure effect on the bladder as the daughter cysts were evacuated repeatedly per urethram after instillations. Spontaneous sealing off of the communication was documented and confirmed by cytoscopy in 1 case. A plea is made to adopt a non-operative approach in such cases, which permits intravesical and, hence, intracystic scolecidal agent instillation and achieves spontaneous evacuation of daughter cysts. Other factors encouraging conservative management whenever possible are the reportedly high recurrence rate of hydatid cysts postoperatively, the morbidity described with complete excision of pelvic and other hydatid cysts, and the inherent slow process of recurrence (between 5 and 20 years) after complete evacuation of daughter cysts.

Prevesical hydatid cyst: A case report

“…22,23 Despite being uncommon, the advent of hydaturia is a pathognomonic symptom, and a sign that the bladder cyst has ruptured. 24 On the contrary, our case complained lower abdominal dull aching pain which worsened over the past 5 months. Otherwise, she did not complain of pressure symptoms like urinary frequency, urgency, retention, and constipation.…”

“…Rarely, they may have progressive renal failure as a result of upper urinary tract obstruction 22,23 . Despite being uncommon, the advent of hydaturia is a pathognomonic symptom, and a sign that the bladder cyst has ruptured 24 . On the contrary, our case complained lower abdominal dull aching pain which worsened over the past 5 months.…”

Unusual bladder outflow obstruction: case report

“…The intravescical instillation of 20% saline to destroy the germinal layer of the hydatid cyst-bladder fistula. That this is helpful has been shown with the consequent reduction of the pressure effects of the bladder as the evacuation of the daughter cysts via the urethra occur after the instillation of scolecidal agents; the sealing of the cyst-bladder communication has also been seen to occur as evidenced cystoscopically (11).…”

Unusual Cause of Dysuria: A Large Primitive Retrovesical Hydatid Cyst

“…They are often associated with digestive signs and symptoms such as constipation or acute hemorrhoidal crisis [8]. The onset of hydaturia is a pathognomonic sign and a sign of rupturing of the cyst in the bladder [10].…”