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| Analysis of the effect of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts |
Yuanshen Mao,Wenfeng Li,Jun Da,Mingxi Xu,Yiwei Wang,Yufei Gu,Weixin Pan( ),Zhong Wang()
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| Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China |
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Abstract Objective: To explore the efficacy, safety, and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.
Methods: From September 2012 to February 2019, a total of 18 patients, aged from 28 to 62 (mean±standard deviation [SD]: 46.50±9.14) years, were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage. There were 10 males and eight females. All of the parapelvic renal cysts were unilateral, and two cases were complicated with pyelolithiasis. The diameters of the cysts ranged from 4.1 cm to 8.2 cm.
Results: All the patients completed the operation successfully in one stage without conversion to open surgery; in two cases, it was difficult to find the cysts during the operation, and the localization was completed by B-ultrasound and percutaneous injection of methylene blue. The mean operative time was 33.89 (SD: 9.68; range: 22-54) min, and the mean hospitalization time was 2.67 (SD: 0.91; range: 2-5) days. Three months and 6 months of follow-up were performed after surgery. The cysts disappeared in 13 (72%) cases, and the diameter of the cysts in five (28%) cases decreased by more than 50%.
Conclusion: Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple, safe, and effective, and can be used as the first choice for the treatment of parapelvic renal cysts.
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Received: 31 July 2020
Available online: 20 April 2023
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Corresponding Authors:
Weixin Pan,Zhong Wang
E-mail: panwx2004@126.com;zhongwang2010@sina.com
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| Patient | Gender | Age, year | Preoperative cyst size, cm | Surgical time, min | Hospital stay, day | Cyst size 3 months after the surgery, cm | Cyst size 6 months after the surgery, cm | | 1 | Male | 45 | 4.8 | 24 | 2 | 0.5 | 0 | | 2 | Male | 49 | 5.2 | 22 | 2 | 2 | 0 | | 3 | Male | 38 | 5.8 | 32 | 4 | 1 | 1 | | 4 | Male | 42 | 6.0 | 38 | 3 | 2 | 1 | | 5 | Male | 28 | 4.1 | 24 | 4 | 2 | 2 | | 6 | Male | 60 | 5.2 | 31 | 2 | 2 | 2 | | 7 | Malea | 51 | 7.0 | 54 | 2 | 0 | 0 | | 8 | Malea | 48 | 4.9 | 52 | 3 | 0 | 0 | | 9 | Male | 62 | 4.3 | 37 | 2 | 0 | 0 | | 10 | Male | 50 | 5.1 | 40 | 5 | 2 | 1 | | 11 | Female | 55 | 7.2 | 39 | 2 | 0 | 0 | | 12 | Female | 60 | 8.2 | 24 | 3 | 0 | 0 | | 13 | Female | 43 | 4.5 | 28 | 3 | 1 | 0 | | 14 | Female | 48 | 5.8 | 24 | 2 | 0 | 0 | | 15 | Female | 47 | 6.1 | 37 | 2 | 2 | 0 | | 16 | Female | 38 | 7.1 | 42 | 2 | 2 | 0 | | 17 | Female | 31 | 4.5 | 24 | 3 | 0 | 0 | | 18 | Female | 42 | 7.0 | 38 | 2 | 2 | 0 |
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Patient characteristics.
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Video screenshots flexible ureteroscopic surgery with holmium laser for a simple parapelvic renal cysts. (A) Light blue or translucent thin tissue slightly convex to the pelvis with reduced vascular texture; (B) Cysts after fenestration; (C) Confirmation of the cystic cavity.
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The puncture needle penetrated into the cyst and could be seen under flexible ureteroscope. The location of the puncture needle showed that the cyst wall was located at 6 o'clock.
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Comparison of preoperative and postoperative CT. (A) Preoperative CT confirming a left parapelvic cyst; (B) CT scan showing that the position of double-J tube was normal and that the proximal portion was located in the cystic cavity; (C) CT scan showing that the cyst disappeared completely 6 months after the operation. CT, computed tomography.
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