Interventional Ultrasound: Puncture and Sclerotherapy of Renal Cysts
Ultrasound-guided puncture and alcoholization are the gold standard technique for the treatment of simple renal cysts. The main indications for the treatment of simple cysts are pain due to the mass compression effect, obstruction of the excretory tract,
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Pasquale Martino, Silvano Palazzo, and Giuseppe Carrieri
15.1 Introduction The treatment of simple renal cysts is generally confined to symptomatic lesions. In particular, the main indications for the treatment of simple cysts are pain due to the mass compression effect, obstruction of the excretory tract, arterial hypertension, and patient anxiety [1, 2]. In general, there is an indication to treat all renal cysts with a longitudinal diameter of 9 cm or more to avoid dangerous intracystic bleeding in cases of
trauma. The principal contraindications to the treatment are hemorrhagic diathesis, severe respiratory failure, gross obesity, and malformations. The therapeutic options for the treatment of renal cysts include open surgery, laparoscopic surgery, and percutaneous procedures. The latter approach is preferred nowadays to avoid the costs and morbidity of surgery [3]. Therefore surgery, both open and laparoscopic, is reserved to those cases in which percutaneous treatment is unsuccessful [3].
Electronic supplementary material The online version of this chapter (doi:10.1007/978-3-319-40782-1_15) contains supplementary material, which is available to authorized users. P. Martino (*) • S. Palazzo Department of Emergency and Organ Transplantation – Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy e-mail: [email protected]; [email protected]; [email protected] G. Carrieri Department of Urology, Policlinico Ospedali Riuniti, University Hospital, Foggia 71100, Italy © Springer International Publishing Switzerland 2017 P. Martino, A.B. Galosi (eds.), Atlas of Ultrasonography in Urology, Andrology, and Nephrology, DOI 10.1007/978-3-319-40782-1_15
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15.2 Technique In the percutaneous approach, an ultrasound probe is used as a “guide” to localize and treat the cyst. Three different types of percutaneous approach can be distinguished: simple, involving drainage, and then normally simple sclerosing [4]. In the simple percutaneous approach (see Video 15.1), the renal cyst is punctured and the content aspirated, under US guidance, for assessment. In fact, in view of the high recurrence rate of renal cysts (30–80 %), this method is generally employed purely for diagnostic purposes to differentiate between cysts containing blood and those with an ample corpuscular component. The second percutaneous method consists of completely emptying the cyst and then positioning a nephrostomic drainage in the cyst cavity for 24 h, to prolong the collapse of the cyst walls. This method, too, is burdened by a high recurrence rate (65–80 %), so a third method has been devised, which consists of introducing a sclerosing solution into the cyst cavity through the drainage, after completely emptying it of its content under US guidance. This treatment aims to sclerose the cyst walls in order to reduce the risk of recurrence. This method can be repeated (for large cysts) after 24 and 48 h [5]. In literature, many different sclerosing substances have been described, but ethanol
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