Midpoint transverse process to pleura block for postoperative analgesia following laparoscopic renal cyst decortication:Two case reports

BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.

Analysis of the effect of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts

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(meanstandard 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.

Analysis of renal cyst of high density containing proteinaceous fluid:report of 6 cases

Objective：To investigate clinical features and imageology of renal cysts of high density, containing proteinaceous fluid and increase the diagnosis and treatment level of this special type renal cyst. Methods：Six cases were proven to be renal cysts of high density（pathologically） from 2002 to 2007 were reviewed. Among 6 cases, 1 was in the upper pole of kidney, 4 were medial and 1 was located in the anus perineum. All were 2-5 cm in size. Ultrasonography（US） excretory unognaphy, multiphase CT and renal angiography DSA imaging was performed for preoperative diagnosis. The preoperative diagnosis found renal neoplasms in 4 and renal cysts in 2, All of them were operated by partial nephrectomy. Results：All of the 6 renal high density renal masses were resected surgically, which were proved pathologically to be renal cysts; high density present. All of them contained proteinaceous fluid with benign cyst walls on histologic examination. No recurrence was seen in any of these cases during a long follow-up. Conclusion：CT and B-US have a higher diagnostic value, which can show the internal shape and character better. B-US or CT guided puncturing biopsy can be better applied to atypical renal cysts. Once the correct diagnosis is acquired, laparoscopic surgical treatment should be carded out.

Hepatocyte nuclear factor 1B mutation in a Chinese family with renal cysts and diabetes syndrome:A case report

BACKGROUND Renal cysts and diabetes(RCAD)syndrome is an autosomal dominant diabetic renal disease.Precise molecular diagnosis of RCAD syndrome has proven valuable for understanding its mechanism and personalized therapy.CASE SUMMARY A RCAD patient and her family were studied to investigate potential responsible genes by the whole exome sequencing(WES).Candidate pathogenic variants were validated by Sanger sequencing.The clinical characteristics of RCAD patient were collected from medical records.Unlike those typical RCAD patients,we observed renal manifestation and prediabetes phenotype,but not reproductive organ phenotype and hypomagnesaemia.A novel 7-bp deletion mutation in exon 4 of the hepatocyte nuclear factor 1B,NM_000458:c.882_888del(p.V294fs),was identified by WES and confirmed by Sanger sequencing.CONCLUSION This novel mutation identified in a Chinese family with RCAD syndrome might be the molecular pathogenic basis of this disorder.

Sustained volume decreases in simple renal cysts after sclerotherapy using NBCA with or without hydrodissection

The present study aimed to determine the effectiveness of sclerotherapy using NBCA(Histoacryl Blue(?);B.Braun,Melgungen,Germany),with or without hydrodissection,for the treatment of simple renal cysts.Materials and Methods:Patients who presented to an interventional radiology clinic for the diagnosis of symptomatic renal cysts which had previously been identified at an outpatient clinic were selected for inclusion in this study.A total of 28 patients were randomly divided into 2 groups,based on whether or not they underwent hydrodissection along with ultrasound-guided NBCA-based sclerotherapy.Sonographs were performed at 0,7,and 180 days postprocedure to record the residual volume of the renal cysts and to determine the efficacy of the procedure.Results:A total of 32 cysts in 28 patients were treated with sclerotherapy,18(64%) females and 10(36%) males.The average age of the patients was 61.8 years(range:33-89 years).All patients reported an improvement in symptoms associated with the existing renal cysts at 7 and 180 days post-procedure,and at 7 days post-procedure a statistically significant reduction in cyst volume was observed(all patients:96.8%;group A:96%;group B:97.6%).The reduced cyst volume was still observed 180 days post-procedure(all patients:98.6%;group A:98.2%;group B:98.9%).There was no significant difference between the two treatment groups.Conclusion: There is a significant and persistent reduction in the volume of renal cysts,in addition to an improvement of the associated symptoms,after treatment with NBCA-based sclerotherapy,with or without hydrodissection.

Assessment of Incidentally Detected Simple Renal Cyst in Pediatric Patient Based on the Modified Bosniak Classification —Incidentally Detected Simple Renal Cyst in Pediatric

Renal cysts in pediatric patients are uncommon lesion. A modified Bosniak classification system for renal cysts based on US has been developed to evaluate pediatric renal cysts to identify the simple cyst or cystic tumour. Nevertheless, it is not widely used. In this retrospective study, all incidentally detected renal cysts by ultrasound performed in children and the reproducibility of modified Bosniak classification to guide the radiological and clinical follow up.

Effect of body mass index on the operation time and postoperative hospital stay of retroperitoneal laparoscopic renal cyst decortication

Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.

Simple Renal Cyst with Clustering of Small Stones in an Elderly Patient withType II Diabetes Mellitus

Intracystic renal stones are rare.The authors wishto report here an aged case of type 2 diabetes mellituscomplicated with sohtary renal cyst with intracysticstones.

Discussion on Traditional Chinese Medicine Understanding of Renal Cyst

The article,from perspective of traditional Chinese medicine(TCM),summarizes etiology as well as pathogenesis,dialectical classification,and treatment method of renal cyst,and concludes that when treating the disease,the first thing to do is to supplement the kidney,then give treatment to the pathogen and tonify qi while attack the pathogen.Additionally,the key of the treatment is to have dynamic observation and timely treatment.In a word,TCM integrated treatment has unique advantage of treating the disease.

Fusion Platform for Renal Cyst Characterization

This work concerns the field of diagnostic aids that facilitate diagnostic decisions for practitioners, especially in medical imaging. The pathology in question, in this study, is the renal cyst. The diagnostic process starts from simultaneous acquisitions of double isotope (Teechnetium-99 m and Iodine-131) scintigraphic images. Then, the platform allows the fusion of these images and the calculation of a pathological parameter that permits the characterization of the state of the dysplasic kidney by comparing it with the normal one. The final result is fusion images annotated by the pathological parameter value.

Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential

BACKGROUND Up until now,no research has been reported on the association between the cli-nical growth rate of multilocular cystic renal neoplasm of low malignant potential(MCRNLMP)and computed tomography(CT)imaging characteristics.Our study sought to examine the correlation between them,with the objective of distin-guishing unique features of MCRNLMP from renal cysts and exploring effective management strategies.AIM To investigate optimal management strategies of MCRNLMP.METHODS We retrospectively collected and analyzed data from 1520 patients,comprising 1444 with renal cysts and 76 with MCRNLMP,who underwent renal cyst decom-pression,radical nephrectomy,or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution.Detection of MC-RNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology.RESULTS Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP.Precisely,it comprises 1.48%of all cases involving simple renal cysts,5.26%of those with complex renal cysts,and a noteworthy 12.11%of renal tumors coexisting with renal cysts,indicating a statistically significant difference(P=0.001).Moreover,MCRNLMP constituted a significant 22.37%of the patient po-pulation whose cysts demonstrated a rapid growth rate of≥2.0 cm/year,whereas it only represented 0.66%among those with a growth rate below 2.0 cm/year.Of the 76 MCRNLMP cases studied,none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis.In the remaining 67 patients,who were actively monitored over a 3-year postoperative period,only one showed suspicious recurrence on CT scans.CONCLUSION MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators.In treating MCRNLMP,partial nephrectomy is preferred,while radical nephrectomy should be minimi-zed.After surgery,active monitoring is advisable to prevent unnecessary nephrectomy.

Successful management of a mixed epithelial and stromal renal tumor masquerading as lower pole renal cyst:A laparoscopic deroofing approach

Background:Renal cysts are common in clinical practice,but some may harbor rare pathological entities such as mixed epithelial and stromal tumors(MEST).Imaging studies are crucial for accurate diagnosis.While laparoscopic deroofing is an established approach for symptomatic renal cysts,encountering MEST within a cyst is uncommon.Case Presentation:We present the case of a 37-year-old female who presented with persistent left flank pain.Imaging revealed a large renal cyst in the lower pole of the left kidney,classified as Bosniak 2.Despite analgesia,the patient's symptoms persisted,leading to a laparoscopic deroofing procedure.Histopathological examination postprocedure revealed a MEST.The patient reported complete resolution of symptoms at the 3-month follow-up.Conclusion:This unique case presents the successful identification and surgical management of a MEST masquerading as a lower pole renal cyst through laparoscopic deroofing.It also contributes to the existing literature by highlighting the importance of considering rare pathological entities in the evaluation of renal cysts and the value of laparoscopic techniques in their management.

Jackstone Caliciel Complicating a Kidney Cyst: Clinical Case and Literature Review

The jackstone is a rare type of urinary stone, recognized for its distinctive shape. While historically described in veterinary pathology, it has also been found in humans, most commonly in the bladder and typically associated with urinary stasis. However, its occurrence in the renal calyx is extremely rare. We report a case of a jackstone located in the renal calyx, secondary to a large Bosniak 1 renal cyst. The simultaneous presence of the calyceal stone and renal cyst prompted us to opt for open surgery, allowing for comprehensive treatment of both conditions. The patient’s postoperative recovery was smooth, demonstrating that despite its invasiveness, open surgery remains a relevant option for managing complex stones, particularly in resource-limited settings.

Systematic review of TCF2 anomalies in renal cysts and diabetes syndrome/maturity onset diabetes of the young type 5

Objective There is a paucity of published works that systematically evaluate gene anomalies or clinical features of patients with renal cysts and diabetes syndrome （RCAD）/maturity onset diabetes of the young type 5 （MODY5）. The purpose of this review was to systematically assess the detection rate, genetic and phenotypic implications of heterozygous autosomal dominant TCF2 anomalies. Data sources MEDLINE database was searched to select articles recorded in English from 1997 to 2008. The focus was monoallelic germline TCF2 gene mutations/deletions. Biallelic inactivation, polymorphisms, DNA modification （hypomethylation and hypermethylation）, loci associated with cancer risk, and somatic TCF2 anomalies were all excluded. Study selection After searching the literature, 50 articles were selected. Results The detection rate of TCF2anomalies was 9.7% and varied considerably among MODY （1.4%）, renal structure anomalies （RSA） （21.4%） and RSA with MODY （41.2%） subgroups. Mutations were strikingly located within the DNA binding domain and varied among exons of the DNA binding domain： exons 2 and 4 were the hottest spots, while mutations were sporadically distributed in exon 3. The consistent phenotypes were RSA （89.6%） and diabetes mellitus （DM） （45.0%）. However, the concurrence of RSA and DM was relatively low （27.5%）, which hinders the optimal performance of genetic testing and obtainment of timely diagnosis. Other organ involvements were complementary and necessary for the early identification of patients with TCF2 anomalies. Analysis of phenotypes of TCF2 point mutations showed significant differences in the detection rates of RSA, impaired renal function （IRF） and DM according to mutation type but not mutation location. Conclusion These valuable features of TCF2 anomalies that previously did not receive sufficient attention should not be neglected.

Efficacy and safety of alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts： a multicenter, prospective, randomized, controlled trial

Background Alcohol has been used for treating simple renal cysts since 1981. Since then, various observational studies have examined the technique, but they differ significantly in the details of the procedures and efficacy measures used. This has made it difficult to assess the safety and efficacy of this technique. We carried out a randomized controlled trial to evaluate the efficacy and safety of ultrasound-guided alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts. Methods A total of 144 patients with simple renal cysts were randomly allocated to either the treatment group （ultrasound-guided percutaneous drainage and alcohol sclerotherapy with single-session multiple injections） or control group （ultrasound-guided simple percutaneous drainage）. Follow-up CT scans of ablated cysts were collected 3 and 6 months after the procedure. The outcome was considered successful if cyst volume between baseline and 6 months decreased by at least 87.5%. Results Intention-to-treat analysis revealed an average volume reduction of 94.2% in the treatment group and 50.8% in the control group （P 〈0.0001）. The percentage of patients achieving successful outcomes was 88.9% （95% CI 77.0%-100.0%） in the treatment group and 22.2% （95% CI 6.54%-37.9%） in the control group （P 〈0.0001）. The corresponding results in the per-protocol analysis were an average volume reduction of 96.4% in the treatment group and 50.8% in the control group （P 〈0.0001）. The percentage of patients achieving a successful outcome was 94,3% （95% CI 85.6%-100.0%） in the treatment group and 22.2% （95% CI 6.54%-37.9%） in the control group （P 〈0.0001 ）. Conclusion Alcohol sclerotherapy involving single-session multiple injections is safe and efficacious in the treatment of renal cysts.

TREATMENT OF SIMPLE RENAL CYSTS BY COLOR DOPPLER ULTRASOUND GUIDED PERCUTANEOUS PUNCTURE CATHETERIZATION DRAINAGE AND 99% ETHANOL PERFUSION

Objective To investigate the effect and safety of the treatment of renal cysts with color Doppler ultrasound guided percutaneous puncture catheterization drainage and repeated 99% ethanol perfusion. MethodsFifty-eight patients with primary renal cysts were treated with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol perfusion. If the cyst volume was<500 mL, the complete evacuation of the cyst was followed by injection with 99% ethanol in a volume equal to 25% of the total cyst volume, twice per day, 10 min for each injection. If the cyst volume was>500 mL, injection was given three times per day, 20 min for each injection, and the patient was asked to move in different positions to help distributing the ethanol over the cyst wall. ResultsFifty-eight cysts were detected in the 58 patients. Puncture was performed and the success rate was 100%. Central venous catheter was introduced into the cysts. After follow-up for 0.5 to 3 years, 56 renal cysts were disappeared. The cure rate was 96.6%, and the complications such as bleeding, infection, and organ injuries were not found. ConclusionThe treatment of renal cyst with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol injection is an effective and safe method for the patients with renal cysts.

Co-existence of renal hydatid cyst and renal cell carcinoma in one kidney: A case report

Rationale:Cystic echinococcosis(hydatid disease)is a parasitic infection of humans,but renal hydatid cyst is rare.It is even more uncommon to find hydatid cyst and renal cell carcinoma(RCC)synchronously in one kidney.Patient concerns:This report presents a 47 years old Iranian man with the chief complaint of lower abdominal pain.Abdominal ultrasound and computed tomographic scan was performed for more evaluation.Diagnosis:RCC was the most probable diagnosis,so he went under left total nephrectomy.Eventually,after histopathologic examination of the excised kidney,cystic echinococcosis came to the first line and papillary RCC was the second diagnosis.Outcomes and lessons:Diagnosis of hydatid cyst and RCC is mostly based on imaging,but,as we noticed in this case,distinguishing between these two may sometimes be difficult due to radiological similarities.

复杂性肾囊肿的术前诊断与外科治疗

肾囊肿是泌尿外科常见的疾病,囊肿体积的增大可能引发疼痛、感染、出血等症状,甚至影响肾脏功能。单纯性肾囊肿恶性风险较低,一般不处理或者选单纯性肾囊肿去顶术急性治疗。复杂性肾囊肿存在着不同程度的恶性风险。在BosniakⅢ级及以上时,恶性风险较高,影像学等检查可能对判断恶性风险及与恶性肾肿瘤的鉴别有帮助。对复杂性肾囊肿的术前充分评估,根据不同的恶性风险选择不同的手术方式以及避免术中囊肿破裂所带来的可能的恶性肿瘤细胞的播散,在复杂性肾囊肿患者的预后很重要。本文将重点讨论复杂性肾囊肿的术前评估,复杂性肾囊肿的外科治疗方法,囊肿处理时避免其破裂的技术要点,囊肿破裂的补救措施等,以期进一步改善复杂性肾囊肿患者的预后。

合并单纯性肾囊肿的急性A型主动脉夹层患者的临床预后特点

目的探讨合并单纯性肾囊肿(simple renal cyst,SRC)的急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者的临床预后特点。方法回顾性分析广东省人民医院2017年6月至2023年6月因ATAAD入院手术患者的病历资料,根据术前主动脉计算机断层扫描血管造影(computed tomography angiography,CTA)检查是否合并有SRC,将患者分为SRC组和无SRC组,将基线资料进行1∶1倾向性评分匹配校准后,比较两组患者围术期相关指标及随访的差异。结果共533例患者纳入研究,两组各有165例进入匹配队列,两组患者在神经系统、循环系统、呼吸系统、泌尿系统、消化系统及其他并发症方面比较,均差异无统计学意义(P>0.05)。术后随访发现,SRC组患者较无SRC组更易发生主动脉事件(P<0.001)。多因素COX回归分析SRC组患者较无SRC组发生主动脉终点事件的风险比为2.545(95%CI:1.668~3.883,P<0.001)。结论SRC的存在不影响多个系统并发症的发生,但是SRC的存在能提高ATAAD患者术后残存主动脉发生主动脉事件的风险。

中国西部首例5G远程机器人辅助肾脏手术(附视频)

本文报道了2023年5月24日甘肃省人民医院泌尿外科应用图迈?腔镜手术机器人完成的中国西部首例5G远程机器人辅助腹腔镜下肾囊肿去顶减压微创手术。手术采用左侧经腹膜外入路完成肾囊肿去顶减压术,手术过程顺利,总手术时间约30 min,术中无明显出血,术后麻醉恢复满意后患者拔除气管插管返回病房,术后引流管引流约10 ml,患者于次日拔除引流管并出院。