Percutaneous Sclerotization of Simple Renal Cysts with 95% Ethanol Followed by 24–48 h Drainage with Nephrostomy Tube

Abstract

Aim of the Study: We propose some technique devices for treating simple renal cysts with percutaneous puncture (PCN) to reduce recurrences. Materials and Methods: Between January 1995 and December 1998, a series of 42 patients, 13 females and 29 males, ranging in age between 49 and 73 were treated for symptomatic kidney cystic disease. The cysts varied between 7.4 and 13.6 cm in diameter and from 100 to 570 cm³ in volume. This technique consists of echo-guided emptying of the cyst, and slowly inserting a quantity of pure 95% ethanol, equivalent to about 1/3 of the cyst volume, into the cavity. This acts as a sclerosant agent on the cyst walls. The protocol of this technique also includes positioning a curled drainage catheter, for 24–48 h, in suction, to ensure a correct collapse of the cyst walls and to avoid cyst recurrence. Results: Of the 42 patients treated, only 4 did not complete the protocol. In 3 cases, the patients were not able to stand the procedure because of intense pain during cyst filling with alcohol. The other patient had intracystic hemorrhage. The results were evaluated by ultrasonography at 7 days post-operatively and then at 1, 3, 6, 9 and 12 months later. There was a further follow-up lasting from 12 to 36 months. Of 38 patients treated, 29 (76%) did not have any recurrence. 8 patients (21%) developed a small liquid layer of 3–4 cm, which did not enlarge in subsequent check-ups. We observed a recurrence, which spontaneously reduced in volume, only in 1 patient. Conclusions: This procedure was simple to apply in an out-patient setting and used low-cost materials which are easily obtained. Moreover, the results appear to confirm the validity of this technique.

Percutaneous Nephrostomy and Sclerotherapy with 96% Ethanol for Treating Simple Renal Cysts: Pilot Study

“…While choosing these agents, complications such as infection and hemorrhage, availability, and cost-effectiveness should be considered. Most studies of the agents have revealed that ethanol injection can yield successful results only compared to aspiration (4,9,14). However, the leakage of phenol or ethanol into the surrounding tissues can cause not only minor complications, such as local tissue corrosions, but also major complications, such as aseptic abscess and severe central nervous system depression (9).…”

Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts

“…Sclerosing agents are believed to produce local inflammation on the luminal surface of cysts and thus result in the adhesion of cyst the walls [4]. Some sclerosing agents; such as glucose, alcohol, pantopaque, phenol, polidocanol, ethanol, bismuth-phosphate, minocycline have been used in other studies [2,3,4,7,8,9,10,12,19]. However, most of them are ineffective or toxic such as pantopaque and have been abandoned at many centers due to reported complications [11,20].…”

“…Simple renal cysts are often silent, their progress slow, and they may become symptomatic because of compression on adjacent urinary tract [3]. Large simple renal cysts leading to pain in the lumbar area, renal or pelvic obstruction, and hypertension require intervention [4].…”

“…A number of sclerosing agents including glucose phenol, iophendylate, bismuth-phosphate, urea cholohydrolactate, polidocanol, minocycline and pantopaque [2][3][4][7][8][9][10][11][12] have been used in the past to prevent simple renal cysts reformation [12]. The purpose of the present study is to evaluate the efficacy of tetracycline hydrochloride, (HCL) as a suspension sclerosant, for the treatment of simple renal cysts.…”

Tissue Chemoablation

“…[120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136] The therapy has been effective in more than 90% of patients after two or three injections. The only direct contraindication to this approach has been a peripelvic cyst.…”