A kidney cyst is a benign formation of a round shape, filled inside with a serous fluid.
Urologists more often encounter single kidney cysts of small diameter, which are located under the kidney capsule (subcapsular).
Cysts are detected in the right and left kidneys with the same frequency. A single large cyst, multiple kidney cysts, polycystic disease, and multicystic disease are much less common.
Where does a kidney cyst come from in a child or congenital cysts?
Cystic neoplasms occur in 1 in 250 newborns. There is a certain division of these developmental defects:
Polycystic
Hereditary pathology, which is characterized by 2-sided kidney damage.
Cause: intrauterine breakdown in the connection of the filtration-reabsorption and urinary units (tubule of the structural units of the kidneys and collecting ducts), as a result of stagnation of urine in the final (proximal) parts of the nephron, they expand with cyst formation.
In children it is often asymptomatic.
The disease is complicated by chronic renal failure.
Multicystic
In multicystic disease, the kidney damage is always one-sided, which occurs due to the absence of the ureteric bud while maintaining the filtration-reabsorption apparatus of the metanephros.
By the time such a child is born, almost all of the renal parenchyma is replaced by fibrous tissue and cysts. According to ultrasound, the kidney resembles a bunch of grapes.
Nephrectomy is indicated, although there are data in the literature on cases of self-resorption of kidney cysts.
Solitary cyst (single)
The neoplasm originates from germinal tubules that have lost connection with the urinary tract. This is the reason that the solitary cyst is isolated from the pelvis.
The accumulation of urine causes its growth and provokes atrophic processes in the perifocal renal tissues and a gradual increase in pain. If the cyst is small, there will be no symptoms.
TO unfavorable factors the existence of a solitary cyst in the kidney is attributed to
the likelihood of infection and malignancy.
A solitary cyst can be single-chamber (contains a single cavity) and multi-chamber, or multiocular (with septa in the cavity).
In childhood, the cyst is rare; it is diagnosed more often in men in the left kidney.
Dermoid cyst- a neoplasm filled with tissue: fat, hair, dental tissue.
Treatment is surgical.
Factors contributing to the appearance of cysts in men and women
Classifications of cysts in the kidneys
Cysts in the kidney are classified by location:
Parenchymal cyst- localized in kidney tissue.
Sinus cyst (cyst in the sinus)– located closer to the pelvis, but has no communication with it.
Subcapsular cyst- directly under the capsule shell, favorable, does not require treatment.
Cortical cyst- cortical layer.
Parapelvic cyst- localization in the area of the renal sinus, most often affecting the left kidney. Most often, it provokes symptoms. They are less common than solitary ones. Most likely, it is congenital.
Multilocular cysts can be located in all parts of the kidney.
First- they do not pose a danger; they are an accidental finding during an ultrasound examination.
Second- cysts with septa that tend to develop.
Third- high risk of malignancy, multilocular, or with aggressive growth in a short period of time.
The contents of kidney cysts can be different: more often - serous, but can be hemorrhagic, purulent or tissue.
Bosniac classification of renal cysts
There is another classification of kidney tumors. It is especially often used by diagnosticians, urologists, surgeons, and oncologists.
Symptoms of a cyst in the kidney
The manifestation of symptoms will depend on the size of the tumor and location.
A simple cyst of small size from 3 to 30 mm, as a rule, does not give any clinical manifestations, therefore, most often, it is discovered when ultrasound examination, appointed for a completely different reason.
For cysts large sizes in the right and left kidney the following is noted clinical picture: dull, aching pain that occurs sporadically in the lumbar region with irradiation in the hypochondrium, arterial hypertension, difficult to correct with medications, a palpable mass formation and the presence of blood in the urine occur in men and women with large kidney cysts. If a kidney cyst in a man or woman begins to grow inward, then due to increasing compression of the parenchyma or blood vessels, complaints appear.
Diagnostic measures for kidney cysts in men and women
Differential diagnosis of kidney cysts is carried out with a kidney tumor, hydatid cyst, polycystic disease, multicystic disease and angiomyolipoma, kidney tuberculoma.
The diagnosis is established on the basis of complaints, objective data and clinical and urological examination data.
Laboratory diagnostics
General clinical analysis blood,
Nechiporenko's sample
general clinical urine test,
biochemical tests: urea, creatinine.
Instrumental diagnostics
Ultrasound of the kidneys,
Survey + excretory urography,
Radioisotope scintigraphy kidney,
MRI of the kidneys with a contrast agent to exclude a neoplastic process in the kidney (malignant nature of the cystic formation (III-IV class).
Ultrasound of the kidneys with Doppler: compression of blood vessels by the cyst
TO additional diagnostics include undergoing examination by a phthisio-urologist to exclude a specific kidney tumor, performing a percutaneous puncture of the cyst for diagnostic purposes to obtain a biopsy sample. Sometimes this is the only way to determine the scope of the operation.
Treatment of kidney cyst
A patient diagnosed with a cystic neoplasm in the kidney is concerned with the questions: “Why is a kidney cyst dangerous?”, “What needs to be done for the cyst to resolve?” and "There are traditional methods treatment for kidney cysts?
Let's try to figure out together in which cases it is worth agreeing to an operation, and in which, without harm to health, you can be treated with the help of folk recipes, with the goal “so that the cyst will resolve.”
First, a little history. Even 30 years ago, when a cyst was discovered in the kidney in a man or woman, the main management tactic was dynamic observation. In cases where any complications arose, open surgical treatment was performed, and if the cyst was of significant size, puncture of the cyst was performed under the control of an ultrasound machine, followed by sclerosis, but there were fewer such operations than open ones.
In what cases is it necessary to operate on a cyst on the kidney?
Men and women whose kidney cyst size does not exceed 3-5 cm in diameter, localized in the periphery, provided that the cyst itself does not manifest itself in any way and does not have a pathological effect, do not need surgery. Dynamic ultrasound of the kidneys is sufficient.
Indications for surgery when a kidney cyst is detected are the following situations:
In addition to the cyst, a man or woman has a circulatory or urodynamic disorder (the cyst has created obstacles to the outflow of urine or is compressing blood vessels).
The cyst is combined with a calculus, which puts pressure on the cyst itself and on the ureter, with planned lithotripsy.
The cyst was complicated by an abscess, paranephritis, etc.
Cyst with a volume of more than 50 ml for young patients.
Cyst rupture.
Bleeding from a kidney with a cyst.
When a biopsy is performed, the punctate contains blood.
Large cysts, increasing the risk of rupture.
Severe clinical symptoms.
Cancer in a cyst.
In older patients and those with severe concomitant pathology, dynamic observation with ultrasound control once every 6-12 months is preferable.
Surgeries for kidney cysts: when which is preferable: percutaneous puncture sclerosis of the cyst or endovideosurgical resection?
The method of choice for a simple kidney cyst (up to 350 ml or up to 3-5 cm) is percutaneous puncture sclerotherapy.
Performing a kidney puncture in modern urology is the initial stage in the treatment of uncomplicated single cysts, the size of which does not exceed 3-5 cm in diameter and are located subcapsularly in the tissues.
After the puncture of the kidney cyst is completed, a sclerosant is mandatory - a special substance that causes the walls of the formation to stick together. This measure prevents the possibility of relapse and repeated surgery.
If we pay attention to the existing statistical data, then after the intraoperative administration of sclerosant, re-formation of the cyst occurs in only 2% of men or women; in the next 3 years, a relapse is recorded in 10-16% of patients.
Contraindications:
A cyst with a volume of more than 350 ml,
Cysts located parapelvically
There is a suspicion of a malignant neoplasm,
Multilocular cyst.
If the cyst is located in the area of the upper pole of the kidney and parapelvically in front, then the operation is performed using a transperitoneal approach; if it is located posteriorly or in the area of the lower pole of the kidney, it is performed using a retroperitoneal approach.
A urologist who knows the endoscopic technique for removing kidney cysts in men and women is necessarily able, if necessary, to proceed to open surgery. Sometimes this happens when kidney cancer is diagnosed intraoperatively.
The most in a modern way removal of a cyst on the kidney is laparoscopy(endovideosurgical operation).
The benefits include:
Low-impact,
the ability to remove cysts of any size and any location,
good visualization surgical field on the video monitor,
fast rehabilitation period,
good healing effect,
absence of rough scars,
safety,
the possibility of treating patients with certain concomitant pathologies,
bloodlessness.
Bloodlessness is achieved by using special ultrasonic scissors and a device that, due to electrothermal effects, seals bleeding vessels with maximum delicacy.
If an endovideosurgical operation is performed on a large cyst with an intraparenchymal location, then the upper part is excised, followed by the introduction of argon-enhanced plasma into the cavity.
When is open surgery preferable?
All complicated cases are a reason for open surgery for a kidney cyst.
Open surgery for a kidney cyst can be performed in different volumes:
Enucleation (husking),
Excision (resection),
Resection of the cyst along with the parenchyma of the renal tissue,
Nephrectomy.
In addition to all the complicated situations with a cyst, there may be a need to correct any concomitant urological pathology, for example, narrowing (stricture of the lumbar spine), staghorn stone.
What are the dangers of kidney cysts?
Even a small cyst can affect the increase blood pressure, and a large kidney cyst can lead to tissue atrophy and chronic renal failure.
Let's say a few words about polycystic disease and its treatment. Polycystic - congenital pathology, in which the entire parenchyma of the kidneys from birth is filled with multiple cysts, due to which the kidneys acquire gigantic sizes. Polycystic disease, as a rule, becomes known already in childhood, and gradually progresses with the loss of functional ability of the kidneys and an increase in blood pressure to high numbers.
There is no need to deal with cysts in polycystic disease, the exception is the condition of cyst suppuration, rupture, bleeding, etc. The doctor’s task in this case is to prescribe therapy that will maximize the pre-dialysis period (dialysis - hardware cleansing of the blood from toxins, metabolic products, etc.)
Treatment of kidney cysts with folk remedies
Note that for the treatment of cysts of large sizes, multi-chambered or with a tendency to constantly develop, recipes traditional medicine cannot be used. Lost time can lead to malignancy of the cyst or to its rupture.
Popular plants that prevent the growth of cysts in the kidney:
Parsley,
burdock,
rosehip root,
celandine,
golden mustache, etc.
Parsley
It has a diuretic and bactericidal effect, slows down the growth of tumors, and prevents infection.
Can be added to salads, as the plant is rich in vitamins and microelements.
To prepare the decoction, take 2 tablespoons of dry parsley (you can buy it at the pharmacy), add 350 ml of water, simmer over low heat for 15–20 minutes, let it brew, add water to 300 ml and take 100 ml 3 times a day for 10 days. months – 6 months.
Golden mustache
Pour 100 grams of crushed golden mustache (preferably “joints”) into 0.5 liters of vodka or diluted medical alcohol. Store the tincture in a cool place in a glass container; shake the bottle periodically.
After 10 days, strain the folk medicine for cysts in the kidney and take 10 drops per 30 ml of water, in the second 11 drops and so on to 35 drops. Then, gradually reducing 1 drop at a time, again reach 10 drops.
After a ten-day break, repeat the course.
From the third course, increase the frequency of taking the tincture to 3 times a day.
Note that the golden mustache with vodka is taken on an empty stomach, 35 minutes before meals.
After six months of treatment, you can do an ultrasound of the kidneys - the cyst should disappear or significantly decrease.
Herbal medicine for kidney cysts (herbal treatment)
Take 20 grams of each raw material:
Yarrow,
Sagebrush,
St. John's wort,
Thuja shoots,
Rose hip,
Burdock.
Grind in a blender, after adding 100 ml of water. Next, add another 200 ml of water to the pulp and simmer for 15 minutes. Strain, top up to the original volume and take ½ cup 3 times a day for 10 days of each month - 3 months.
What to look for if you have a kidney cyst
Conservative therapy for getting rid of a cyst is ineffective, but if you set goals to prevent the development of infection and maintain the functional ability of the kidneys, this is quite achievable.
Note that when a kidney cyst is detected for the first time, if it is already of sufficient size, the patient is registered at the dispensary with a frequency of examinations 2 times a year. In spring and autumn, a preventive course of uroseptics and herbal diuretics is prescribed.
You can take Canephron in courses of 1 month, 2-3 times a year.
It is necessary to exclude everything spicy, sour, salty, and smoked from your diet.
You cannot visit the sauna and solarium, you should not expose yourself to direct sun rays- all this can provoke the growth of a cyst in the kidney.
You should forget about physiotherapeutic procedures for the lumbar region.
You cannot apply therapeutic mud, apply warming creams, or do massage.
A cyst in the kidney is not so bad rare disease, but with the correct behavior of the patient, many troubles can be avoided.
A kidney cyst is a neoplasm that forms on the side of the upper layer of the kidney; the type of neoplasm is cavitary, the nature is benign, however, under certain conditions, there is a risk of malignancy of the process. Kidney cysts, the symptoms of which mainly appear in men at an average age of 45-50 years, are much less common in women. Considering the noted tendency to transform into a malignant process, a kidney cyst requires constant monitoring of this neoplasm for timely action, which is not always possible due to the long absence of symptoms (hidden course).
general description
The cystic formation that forms in the phenomenon we are considering is cavitary, in the form of a capsule with serous contents in it. In general, a cyst can have a completely different shape; it can be either simple and have one cavity, or multi-chambered, that is, complex, with a large number of cavities. In general, such formations do not reach large sizes; therefore, it can be added based on the general trend and statistics that cystic formations extremely rarely reach sizes of 10 cm or more.
Despite the fact that kidney cysts are diagnosed quite often in urology, the etiological features of the development of this neoplasm are still not fully understood. There are some theories about this. Considering that there are many types of cysts, and also that they often manifest themselves in atypical form and the fact that, in addition to other associated factors, patients seek the help of a doctor quite late, the possibility of forming a general etiological basis for the disease is not yet available.
One of the most common reasons that provoke the formation of cysts is pathology renal tubule, through which urine outflow usually occurs in its normal state. When urine accumulates in the tubule, it begins to stagnate, which, in turn, leads to the formation of a characteristic protrusion of the wall, which gradually begins to transform into a cyst. As for determining the factors against which urinary stagnation may develop, here we can identify any type of kidney pathology or kidney dysfunction. For example, this could be tuberculosis, urolithiasis (kidney stones), an oncological process, an inflammatory process in the environment of the renal pelvis (meaning a disease such as pyelonephritis), as well as any injury in this area.
Basically, a kidney cyst contains serous fluid; in addition, it may contain an admixture of blood, kidney fluid, and pus. Certain cystic formations form in parallel with internal tumor formations localized directly on their walls.
Depending on its origin, a kidney cyst can be congenital or acquired. In addition, in addition to this division, one can identify a condition such as polycystic kidney disease, in which such cysts appear on the parenchyma in multiple numbers.
Kidney cysts: classification
As we have already indicated, kidney cysts can be congenital or acquired according to the nature of their manifestation.
Congenital cystic formations may appear in the following forms:
- Solitary renal cyst. Such a cyst is also benign; it is either round or oval in shape. There are no constrictions, no connections with ducts. There is a serous fluid inside, in some cases there is an admixture in the form of pus or blood. Basically, such a cyst develops only when one kidney is affected, after a previous injury. In approximately half of the cases, this type of cyst is detected simultaneously in several places on the affected kidney. Characteristic feature This form is that most often it manifests itself as a solitary cyst of the left kidney and is diagnosed in the vast majority of men.
- Multicystic. In this case, we are talking about congenital damage to one of the kidneys. This form of pathology is diagnosed very rarely. With the development of a severe form of this type of pathology, the kidney is externally transformed into one continuous cyst, which, due to the scale of the lesion, deprives it of its inherent functions (in other words, the kidney cyst becomes incapacitated). In addition, in some cases, even with this type of pathology development, the affected kidney may remain small in size. healthy area, which ensures the production of a small amount of urine that accumulates in the cavities of the cysts.
- Polycystic disease. In this case, both kidneys are affected simultaneously. Due to the multiple formation of cysts, the appearance changes so much that they begin to resemble bunches of grapes. Predominantly genetic predisposition is the main factor provoking the development of polycystic kidney disease.
- Spongy kidney (otherwise known as multicystic medulla). Congenital pathology, accompanied by dilation of the renal tubules with the concomitant formation of multiple small cysts.
- Kidney dermoid cyst (or dermoid). A congenital form of pathology, accompanied by the formation of cysts, inside of which components of the ectoderm are found. Such components can be considered fat, epidermis, bone inclusions, hair, etc.
- Cystic formations in the kidneys caused by concomitant hereditary syndromes (tuberculous sclerosis, Zellweger syndrome, Meckel syndrome, etc.).
With a general examination of cysts, the reader may notice that kidney damage can be either unilateral or bilateral, which also determines a separate position for them in the general classification.
Depending on the location, a kidney cyst may correspond to the following location options:
- subcapsular kidney cyst - in this case the cyst is located under the fibrous layer of the affected organ;
- intraparenchymal kidney cyst - the cyst is concentrated directly in the parenchyma (organ tissue);
- cortical kidney cyst - the location of the cyst is in the sinus of the organ;
- parapelvic kidney cyst - location of the cyst within the sinus area of the organ.
Depending on the structure of the kidney cyst, the neoplasm can be single-cavitary (solid, single-chamber) or multi-chambered - in this case, the neoplasm has septa.
Depending on the contents of the cysts, there is also a separate distribution:
- Serum serous content– has a transparent consistency, yellowish tint. Serous matter is a fluid that penetrates into cystic formations through the capillary walls.
- Hemorrhagic contents– here we are talking about the admixture of blood in the contents of the cyst. Such content appears in neoplasms formed against the background of a heart attack or kidney injury.
- Purulent contents– here, as is clear, there is an admixture of pus in the cystic formation, which may be the result of transfer infectious disease patient.
- Calcifications– Quite often the contents of cysts are found in the form of stones.
Cystic neoplasms may also fit into certain categories, which are defined according to their characteristics:
- I category. This category includes the most common form of benign cystic formations; they can be detected without any difficulty during ultrasound examination.
- II category. This category includes benign neoplasms that have certain changes and membranes. In this case, we are talking about infected, hyperdense or calcified forms; they reach 3 centimeters in diameter.
- III category. This includes cysts that are prone to malignancy. Because of this, their membranes and membranes thicken. It is extremely difficult to detect such cysts during X-ray examination. In addition, treatment of the cyst in this case should be carried out immediately, through appropriate surgical intervention.
To summarize, we can simultaneously identify the main causes of kidney cysts, which in one way or another affect their characteristics:
- tumor formations in the kidneys (in one or both);
- pyelonephritis;
- sand, kidney stones;
- kidney injury;
- kidney tuberculosis;
- intoxication of the body (including medicinal);
- ischemic or venous infarction of the kidney;
- kidney hematoma, damage to the fibrous capsule of the organ.
Kidney cyst: symptoms
The determining factor in the manifestation of the symptoms of the disease in question can be identified by its inherent dimensions. The initial stage of cyst development is characterized by its small size, therefore the course of the disease as a whole is characterized by the absence of any specific symptoms.
Meanwhile, the gradual growth of the tumor causes pressure on the renal pelvis or ureter. It is from this time that the first symptoms of a kidney cyst appear. These include the appearance of a feeling of heaviness, concentrated in the lumbar region, and aching pain in this area may also be noted. Mostly pain syndrome It is distinguished by its clear localization on the side on which the kidney is affected, that is, where the cyst is located.
When the cyst becomes large enough, the outflow of urine from the kidney may be disrupted, which, in turn, causes fluid stagnation. This phenomenon becomes a predisposing factor for joining pathological process secondary infection. With this option, the clinical picture is accompanied by symptoms in the form of fever, weakness, chills, severe pain in the lumbar region (with their spread to the genitals). In this case, the urine changes, becoming cloudy.
What is noteworthy is that the infection discussed above begins to develop not only in the affected organ, that is, in the kidney, but also directly in the cyst. This course is accompanied by a picture characteristic of an abscess, which is also accompanied by acute pain in the lumbar region on the affected side and elevated temperature. Suppuration of an inflamed cyst or its rupture is accompanied by symptoms characteristic of acute abdomen. This implies a pronounced tension in the muscle area from the front abdominal wall, as well as the presence of pain, noted not only in the lumbar region, but also in the abdomen.
The long course of this disease can be characterized by the manifestation of a picture accompanying the chronic form of renal failure. In this case, an increase in the total amount of urine and its subsequent complete disappearance is characteristic. Also accompanying symptoms are the presence of blood in the urine and high blood pressure.
Kidney cyst: complications
The most common of possible complications kidney cysts secrete its rupture. Even a minor impact can lead to it. This is accompanied by the outflow of the contents of the cyst directly into the abdominal cavity, which is why it, the cavity, becomes inflamed (peritonitis develops). Peritonitis is an extremely serious condition requiring surgical intervention.
In addition to rupture, suppuration of the cyst may also develop, which is accompanied by weakness, acute pain in the lower back and fever. This condition also requires surgical intervention followed by antibiotic therapy.
If the cyst becomes large enough in size, then the vascular structures of the kidney are subject to disruption due to compression. In this case, its functioning is disrupted, in addition to this, uremia develops - self-poisoning of the body as a result of actual renal failure (the blood becomes infected with kidney toxins). Basically, this variant of the development of the disease is characteristic of a bilateral pathological process, although it cannot be excluded if only one of the kidneys is affected.
And finally, as a complication we can identify the possibility of malignancy of the pathological process, that is, its transformation from benign process into a malignant process.
Diagnosis
In the diagnosis of kidney cysts they are used traditional methods diagnostics In particular, these are ultrasound, CT and MRI - based on the results of the data diagnostic methods you can get a detailed and clear picture of the structure of the cysts and the features of their location.
In addition, a radioisotope study of the functions of the kidney organs is used, on the basis of which the nature of the process can be confirmed (or, conversely, excluded), that is, it can be determined whether the process is malignant or benign. Such methods are Dopplerography, urography, angiography and scintigraphy.
In addition to these diagnostic methods, blood tests (biochemistry and general) and urine tests are also indicated.
Treatment
The most common method of treating a cyst is a wait-and-see approach, in which dynamic control over the condition of the cyst becomes the basis. This kind of control allows you to timely determine when the cyst begins to grow, which already requires appropriate surgical intervention. In turn, the last measure of influence on the cyst, surgery, is carried out when the cyst has become an obstacle to the normal functioning of the affected organ.
In addition to surgery, treatment of a kidney cyst also requires implementation conservative methods, which in particular lies in the need to use painkillers and antibiotics during the postoperative period.
I would like to describe the treatment of kidney cysts with folk remedies separately. It is important to understand that such treatment is not only ineffective in the fight against the disease we are considering, but can also be dangerous (depending on the degree of damage, the type of cyst and the stage of the actual pathological process and other features accompanying the pathological process). Besides the absence positive results any such treatment can not only cause the patient to waste time in unnecessary treatment, but, on the contrary, due to overly active influence of the methods of treatment used, cyst rupture can be provoked. As has already been indicated, in this case its contents will spill into the abdominal cavity, which will provoke peritonitis, in which urgent surgical intervention and even more serious consequences cannot be avoided. The maximum that can be used among such measures is some herbal decoctions.
Regardless of the options you take, it is also important to make certain adjustments to your lifestyle. In particular, it is necessary to reduce the amount of salt consumption in diet products and salty foods. The volume of fluid consumed should also be monitored, especially if there is a tendency for progressive swelling. Restrictions also apply to the consumption of protein foods; coffee and products containing cocoa, seafood, and sea fish are excluded. A special place is occupied by the need to give up alcohol and smoking.
The prognosis for a kidney cyst may correspond to the following options:
- The detection of a congenital form of multiformations (multiple cysts of one type or another) in a patient with damage to both kidneys determines an unfavorable prognosis for him; moreover, in this case, kidney cysts are incompatible with life.
- When congenital forms of autosomal recessive formations are identified, the prognosis is also unfavorable. In this case, infants extremely rarely survive beyond the age of two months.
An almost 100% positive prognosis is determined for a simple kidney cyst, and this option is relevant regardless of the treatment tactics implemented (surgery or conservative therapy).
If symptoms appear that may indicate the presence of a kidney cyst, you should contact a nephrologist or urologist.
There is a huge variety of benign neoplasms. A common one among them is a single kidney cyst. The disease is diagnosed in 70% of patients suffering from diseases of the internal organ. In a single case and with small sizes, it does not cause any problems for the owner. If there are complications, then it brings many problems, even organ failure. What is the most important thing to know about this formation, why is it dangerous and how is it treated?
Cysts are very common in people with kidney health problems.
General information
The size of the cyst sometimes reaches 10 cm in diameter. In this case, it is removed.
This is a benign formation, in the middle it contains fluid (in the case of a cyst in the kidneys, this is urine), and on the outside it is covered with tissue cells (depending on the type, they thicken). Outwardly it resembles a ball or ellipsoid. The size varies depending on the “age” of the formation (from 0.5 cm to 10 cm or more in diameter): the older it is, the larger it is, and vice versa. Most often these are single formations, but multiple neoplasms also occur (in this case, doctors advise removing the entire affected organ). The most common are cysts of both kidneys or a cyst of the left kidney. There is a combination of liver and kidney formations. The adrenal glands are not affected.
Classification and types of kidney cysts
Kidney cysts can be extensive or local. There are a huge number of varieties of this disease. They depend on the location, content, nature of the formation, as well as the risk to the patient. Knowledge of this classification will help the patient evaluate the pros and cons for selecting treatment, in particular surgery. Young parents also need to know it: formations are common in newborns, in addition, it will explain the undesirability of communicating with yard dogs. The types of kidney cysts, as well as their shape, are varied. There are many different classifications:
| Criterion | Kinds |
| Intimacy | Single-chamber (simple) and multi-chamber (complex renal cyst). Septa may form in the middle of the cyst. |
| Quantity | The cyst can be single or multiple |
| Origin | Congenital and acquired |
| Place | Kidney parenchyma, cortex, under the capsule, pelvis. |
| Fluid formation | Sulfur, pus, hemorrhagic (collection of blood) or complex |
| Number of affected kidneys | Single and double sided |
| Categories |
|
Acquired and congenital
Acquired kidney cysts (AKC) are a consequence of inflammatory processes in the organ, as well as kidney tuberculosis. They are usually simple, small in size, but sometimes with the wrong lifestyle, they become large in size and turn to malignant formations. Diagnosed more often in women over 45 years of age. Probability of occurrence in humans younger age is 30%. Formations in newborns are common and have many varieties. More often it is an acquired disease. The following subtypes of neoplasms are both congenital and acquired. These varieties have the same structure and symptoms.
A sinus cyst is localized inside the kidneys, near the vascular pedicle. Sinus, solitary and parenchymal
A sinus cyst is located inside the kidney itself near the sinus (vascular pedicle near the hilum). It is small in size and has a round shape. A solitary cyst appears in the upper part of the kidney, usually simple, filled with sulfur. Can reach significant sizes. Parenchymal filled with sulfur mixed with blood plasma, located inside the kidney. It can be multiple.
These types of tumors are not dangerous, but without treatment they can cause serious complications.
Subcapsular, parapelvical and avascular
Subcapsular is a type of solitary. The difference is that it appears as a result of severe injury to the kidney and inside, in addition to sulfur, there is pus or blood. Parapelvic cysts are very rare, usually in elderly people on the left kidney. They do not bring any concern to their owner; their properties are similar to sinus. Avascular is located far from the portal of the kidney, is not supplied with blood, but is nourished by the renal tissue. Very quickly goes into the malignant section. You should not wait for complications; you must begin correct treatment immediately.
Causes and mechanism of development
The main causes of cysts have not been fully identified. The formation of cysts depends on many factors. In newborns, they are the result of a genetic predisposition, and acquired ones appear as a result of injury, health problems (we are talking not only about kidney disease, but also about cardiovascular disease) or the activity of certain organisms. Often the cause of cyst formation is kidney stones. In 5% of cases, a kidney cyst is congenital. The formation of a cyst begins on the walls of blood vessels; initially it is small in size and feeds from the vessel. Kidney cysts are more common in women than in men.
Symptoms and signs in men and women are almost the same and depend on the size of the formation. If the cystic neoplasm is small, the patient does not feel its presence. A large cyst causes blood stagnation and inflammation. This leads to increased temperature, pain in the kidney or abdominal cavity (sometimes it radiates to the lower back, hypochondrium, groin), blood in the urine. In addition, a large number of leukocytes and protein are found in the urine. In women with large sizes, cystic formation is determined by palpation. Symptoms include painful urination and swelling. This happens because the internal organ is not able to remove the required amount of fluid.
1Symptoms vary depending on the type of formation and its size. It is important to pay attention to them in time to prevent the irreparable.
This paper demonstrates the effectiveness of the laparoscopic method in the surgical treatment of giant renal cysts. A 57-year-old patient was admitted to the clinic with complaints of constant dull, aching pain in the right lumbar region. CT scan: in the area of the anterior, posterior segments and upper pole of the kidney, a solitary cyst measuring 16.5×12.5×10 cm is detected. In the left kidney, four cysts ranging in size from 1.5 to 5.0 cm are detected. Diagnosis: giant cyst of the right kidney , multiple cysts of the left kidney, ischemic disease heart, atherosclerotic cardiosclerosis. The patient underwent laparoscopic transperitoneal removal of a giant cyst of the right kidney. The duration of the operation was 75 minutes, intraoperative blood loss was 20 ml, hospitalization time was 2 days. The result of pathohistological examination: the walls of the excised cyst consist of fibrous tissue. The patient was under observation; studies carried out one year after the operation revealed satisfactory function of the right kidney, absence of pyelectasia, hydronephrosis and signs of cyst recurrence. Marsupilization of giant kidney cysts using laparoscopic technique is the optimal and least invasive method surgical treatment.
giant kidney cyst
laparoscopy
1. Endovideosurgical methods for excision of simple kidney cysts / Z.A. Kadyrov, A.A. Samko, Sh.Sh. Gurbanov et al. // Experimental and clinical urology. – 2010. – No. 3. – pp. 62–65.
2. Lopatkin N.A., Mazo E.B. Simple renal cyst. – M.: Medicine 1982. – 128 p.
3. Stepanov V.N., Kadyrov Z.A., Atlas of laparoscopic operations in urology - M.: Miklosh, 2001. - P. 120.
4. Bellman G.C., Yamaguchi R., Kaswick J. Laparoscopic evaluation of indeterminate renal cysts. Urology. – 1995 Jun. – No. 45 (6). – R. 1066–70.
5. Bishoff J.T., Kavoussi L.P. Atlas of laparoscopic retroperitoneal surgery. – 2002. – 398 p.
6. Bosniak MA. Diagnosis and management of patients with complicated cystic lesions of the kidney // AJR Am J Roentgenol. – 1997 Sep. – No. 169 (3). – R. 819–21.
7. Ehrlich RM, Gershman A, Fuchs G. Laparoscopic renal surgery in children // J Urol. – 1994 Mar. – No. 151 (3). – R. 735–9.
8. Gill I.S. Textbook of laparoscopic urology. – New York, 2006. – 1202 p.
9. Hanash K.A., Al-Othman K., Mokhtar A., Al-Ghamdi A. Laparoscopic ablation of giant renal cyst // J. Endourol. – 2003 Nov. – No. 17 (9). – R. 781–4.
10. Hemal AK. Laparoscopic management of renal cystic disease. Urol Clin North Am. – 2001. – No. 28. – P. 115–126.
11. Hulbert JC. Laparoscopic management of renal cystic disease // Semin Urol. – 1992 Nov. – No. 10 (4). – R. 239–41.
12. Laparoscopic transperitoneal decortication of a giant peripelvic renal cyst / A. Mingoli, G. Brachini, B. Binda et all. // J Laparoendosc Adv Surg Tech A. – 2008 Dec. – No. 18 (6). – R. 845–7.
13. Nieh P.T., Bihrle W. 3rd. Laparoscopic marsupialization of massive renal cyst // J Urol. – 1993 Jul. – No. 150 (1). – R. 171–3.
14. Singh I., Sharma D., Singh N. Retroperitoneoscopic deroofing of a giant renal cyst in a solitary functioning hydronephrotic kidney with a 3-port technique // Surg Laparosc Endosc Percutan Tech. – 2003 Dec. – No. 13 (6). – R. 404–8.
15. Youness A, Abdelhak K, Mohammed F. et all. Remission of hypertension after treatment of giant simple renal cyst: a case report // Cases J. – 2009. – No. 2. – 9152 rub.
Kidney cyst is common benign lesion kidneys and occurs in at least 24% of people over 40 years of age and in 50% of people over 50 years of age. Due to the development of diagnostic methods, the detection of kidney cysts throughout the world is increasing.
Renal cysts may obstruct the collecting system, compress the renal parenchyma, or cause spontaneous hemorrhage, inducing pain and hematuria. Additionally, they can become infected or can cause obstructive uropathy and hypertension. Not so long ago, before endoscopic surgical methods began to be widely used in medicine, a patient with a kidney cyst was mainly offered dynamic monitoring of the size of the cyst. According to indications, open surgery was performed, which was not always feasible due to concomitant pathology.
Bosniak (1997) developed a convenient classification that divides renal cysts into categories according to the degree of their possible malignancy:
Category II - benign, minimally complicated cysts, which are characterized by the appearance of septations, calcium deposition in their walls, infected cysts, and hyperdense cysts. This category of cysts almost never becomes malignant and requires dynamic ultrasound monitoring.
Category III - This group is more uncertain and tends to become malignant. Radiologic features include ill-defined contour, thickened septa, and patchy areas of calcium deposition for which surgical treatment is indicated.
Category IV - formations have a large liquid component, an uneven and even lumpy contour and, most importantly, in some places they accumulate a contrast agent due to the tissue component, which indirectly indicates malignancy.
Indications for surgery for a kidney cyst are: compression by the cyst urinary tract, compression of the kidney tissue by the cyst, infection of the cyst cavity and formation of an abscess, rupture of the cyst, large size of the cyst, pain symptom and malignant hypertension. Most patients with cysts larger than 3 cm begin to experience pain sooner or later. Giant kidney cysts measuring more than 15 cm are a rather rare observation in practice.
Hulbert in 1992 was the first to perform and describe the technique of laparoscopic cystectomy. This technique allows the removal of solitary, multiple, peripelvical and bilateral renal cysts in a single operation. Today, cystectomy is performed using laparoscopic and retroperitoneoscopic methods. The laparoscopic approach is a minimally invasive method that allows decompression of cysts under direct visual control. Laparoscopy is an effective treatment for patients with autosomal dominant polycystic kidney disease who experience pain symptoms (Bosniak II and III).
In the literature available to us, we found only a few cases of laparoscopic removal of giant renal cysts. The case we presented is a rather rare observation in urological practice and, in our opinion, will arouse interest among colleagues.
Goal of the work - to clearly demonstrate the effectiveness of the laparoscopic method in the surgical treatment of giant renal cysts.
Material and research methods
Patient X., 57 years old, was admitted to the urological clinic of the Azerbaijan Medical University in November 2010 with complaints of constant dull, aching pain in the right lumbar region. According to the patient, the disease began approximately 4 months before hospitalization. Upon admission, the general condition was satisfactory. From the cardiovascular system, coronary heart disease and atherosclerotic cardiosclerosis are noted. Indicators of general and biochemical blood tests are within normal limits. With ultrasound examination (ultrasound) and contrast computed tomography (CT) in the abdominal organs pathological changes not detected. Dimensions, thickness of parenchyma and functional state kidneys are satisfactory. In the area of the anterior, posterior segments and upper pole of the kidney, a solitary cyst measuring 16.5×12.5×10 cm is determined (Fig. 1). The cyst has no adhesions to the right lobe of the liver. Four cysts measuring 1.5×1.5 are identified in the left kidney; 1.8×1.7; 3.1×2.4; 5.4×5.0 cm (Fig. 2). Abdominal and retroperitoneal lymph nodes are unchanged. The patient was diagnosed with a giant cyst of the right kidney, multiple cysts of the left kidney, coronary heart disease, atherosclerotic cardiosclerosis.
Rice. 1. Ultrasound of the patient before surgery. Giant cyst of the right kidney. The kidney is not visualized due to the large size of the cyst.
The patient underwent laparoscopic transperitoneal removal of a giant cyst of the right kidney.
The patient is positioned in the lateral decubitus position at an angle of 45 degrees. Given the location of the cyst, the first port (11 mm) was placed 2 cm above and distal to the umbilicus and a pneumoperitoneum was created. Next, two more ports (13 and 5 mm) were installed under laparoscopic control. After separating the adhesions in the abdominal cavity, the peritoneum was incised along back wall the abdominal cavity along the white line of Toldt to the hepatic flexure of the colon, then the colon was separated from the tissues of the retroperitoneal space and Gerota's fascia was exposed. The outer surface of the cyst was completely mobilized from the surrounding tissue (Fig. 3).
Rice. 2. Computed tomography of the patient before surgery. Giant cyst of the right kidney, kidney tissue is pushed under the liver and towards the spine
Rice. 3. Mobilized giant renal cyst
Next, it was opened in a small area and aspiration of the contents, which amounted to 1.6 liters. To excise the walls of the cyst, a device for dosed electrothermal tissue ligation “Liga sure” and endoscissors with coagulation were used. After complete excision of the cyst edges, a drainage tube was installed (Fig. 4). The duration of insufflation was 65 minutes, the duration of the operation was 75 minutes. Intraoperative bleeding - 20 ml. Hospitalization time 2 days. On the first day, discharge from the drainage tube amounted to 40 ml; on the second day, no discharge was observed. The drainage tube was removed, and the patient was discharged in satisfactory condition. The result of pathohistological examination: the walls of the excised cyst consist of fibrous tissue.
Research results and discussion
Laparoscopic surgery for kidney cysts is a modern and low-traumatic method for radical removal of cysts. This method allows any intervention on the cyst, including nephrectomy. For intraparenchymal renal cyst, when there is high risk damage to the renal cavity system, the patient must be warned before laparoscopic surgery about the possibility of expanding the scope of the intervention. This may be cyst enucleation, kidney resection, or nephrectomy.
Rice. 4. Patient after surgery
Naturally, a kidney cyst is not always an indication for surgical intervention or even active action. Most often, if the cyst does not bother the patient, and even more so if he did not even suspect its presence, dynamic observation is sufficient. This means that every six months to a year the patient must be examined by a doctor and undergo research (usually an ultrasound of the kidneys).
The wall of the cyst consists of a connective tissue capsule lined with squamous and cuboidal epithelium, in the vast majority of cases with chronic inflammation. In addition, in some patients, histological examination reveals muscle fibers in the cyst wall. The fibrous capsule of the cyst is lined from the inside with epithelium resembling endothelium or mesothelium, and degenerated nephrons, smooth muscle fibers and cells are found in the collagen tissue of the cyst wall chronic inflammation. The epithelium of the cyst may be discontinuous. In many patients, the epithelial lining of the cyst is absent. In some places of the capsule the epithelium disappears or atrophies, while in others, on the contrary, it has 2-3 layers of cells. In some cases, lime deposits, embryonic inclusions, remnants of kidney and even adrenal tissue are observed in the thickness of the cyst wall. The deposition of lime in the walls of the cyst indicates its “old” age.
How transparent and pure the consistency of the liquid contents of the cyst during aspiration is, the greater the likelihood of a benign process in the kidney. With giant cysts, the presence of a malignant process in the kidney has not been described in the literature. In the patient we presented, during aspiration, we observed clean and transparent liquid, the volume of which was more than 1600 ml, without the presence of hemorrhages and signs of inflammation. The size of the cyst, the structure of its wall, and the consistency of the contents did not cause us to suspect the presence of a malignant process during the operation, which was also confirmed by pathohistological examination data.
Laparoscopic resection of a kidney cyst is an effective intervention with a low number of complications and rapid rehabilitation of patients. Emerging intraoperative complications can be eliminated without conversion if the operating surgeon has sufficient skills and appropriate equipment in the operating room. With sufficient experience and skill, the retroperitoneoscopic approach is less invasive and minimizes (though does not eliminate) the risk of internal organ injury. But in this case, we performed surgical intervention using a transperitoneal approach. We made this decision based on the gigantic size and location of the cyst. The transperitoneal approach allowed us to completely mobilize the extrarenal areas of the cyst from the surrounding tissues; no intraoperative complications were observed.
The success of laparoscopic ablation of a renal cyst is symptomatic relief, observed on average in 97% of patients and the absence of signs of cyst recurrence in 92% of patients, which is superior in effectiveness to other methods surgical treatment.
Our patient's main complaints were constant dull and recurrent sharp pains in the right side, especially occurring when lying on the right side. After surgery, the patient completely disappeared from pain, his general condition was satisfactory a day later, and after a few days he returned to active life. The patient was under observation; studies carried out one year after the operation revealed satisfactory function of the right kidney, absence of pyelectasia, hydronephrosis and signs of cyst recurrence. The patient was in perfect health and had no complaints.
Conclusion
An analysis of the world literature and our experience in treating patients with renal cysts have shown that laparoscopic and retroperitoneoscopic resection of renal cysts is currently considered a safe and effective treatment method.
Laparoscopy allows the surgeon to take a minimally invasive approach to evaluate and treat this category of renal pathology. The cyst as a whole can be completely examined under direct visual control and excised. In addition, decortication or marsupialization can be performed without subjecting the patient to open surgery. This minimally invasive approach not only has diagnostic and therapeutic benefits, but also shortens postoperative morbidity and patient recovery compared to traditional open surgery approaches.
The case we presented once again confirms the opinion that using laparoscopic access it is possible to remove a kidney cyst of any size and location. Marsupilization of giant kidney cysts using laparoscopic techniques is the optimal and least invasive method of surgical treatment.
Reviewers:
Jamalov F.G., Doctor of Medical Sciences, Associate Professor of the Department of Surgery, Faculty of Pediatrics, Azerbaijan Medical University, Baku;
Abdullaev K.I., Doctor of Medical Sciences, Professor, Director of the Urological Center LLC, Baku.
The work was received by the editor on 04/05/2012.
Bibliographic link
Imamverdiev S.B., Nagiev R.N., Astanov Yu.M. LAPAROSCOPIC REMOVAL OF A GIANT KIDNEY CYST // Basic Research. – 2012. – No. 5-1. – P. 31-35;URL: http://fundamental-research.ru/ru/article/view?id=29841 (access date: 07/10/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"
Kidney cyst - surgery
Does every fluid formation in the kidney really need to be operated on? No, not everyone.
You need to operate if:
We offer the following surgeries for kidney cysts:
Why is a kidney cyst dangerous?
Diagnosis of kidney cysts
Treatment and operations
How to get to us:
Moscow Center for Innovative Urology
By public transport:
When moving from Koltsevaya, the last car, exit to Solyansky Proezd. When exiting, turn right and move about 100 meters in a straight line to the intersection with a traffic light. At the intersection, turn right onto Solyanka Street, after 170 meters there will be the Church of the Birth of the Virgin Mary, go around it on the left, and after 100 meters turn left onto Maly Ivanovsky Lane. After about 60 meters, the entrance to the clinic will be on your right.
Open surgical treatment of a giant renal cyst against the background of an arteriovenous fistula of the right renal artery
Shlomin V.V. Grebenkina N.Yu. Bondarenko P.B. Puzdryak P.D. Dorofeev S.Ya. Pyaterichenko I.A. Vereshchako G.A.
Branch vascular surgery, City Multidisciplinary Hospital No. 2, St. Petersburg, Russia
Presented clinical case open surgical treatment of arteriovenous fistula renal artery with a large venous aneurysm at the hilum of the right kidney and a giant cyst of the upper pole in a 28-year-old patient. During the operation, separation of the arteriovenous fistula was revealed with suturing of the arterial defect at the edge. The venous aneurysm at the hilum of the right kidney was excised and sutured at the edge, and the additional varicose renal vein was ligated. The postoperative period proceeded without complications. After 3 months, on control MSCT angiography, the venous aneurysm was thrombosed, with no signs of admission arterial blood not found. The excretory function of the kidney is preserved. The article discusses options for diagnosis, treatment of arteriovenous fistula of this location and its complications.
KEYWORDS. arteriovenous fistula, venous aneurysm, giant renal cyst.
INTRODUCTION
Renal arteriovenous fistulas are pathological communications between the arterial and venous systems kidneys Arteriovenous fistulas (AVFs) can be congenital, acquired, or idiopathic. Congenital arteriovenous fistulas are divided into varicose and cavernous. Most AVFs are of the classic varicose type, in which the vessels have a dilated, tortuous appearance, resembling varicose veins. Anatomically, varicose AVF is characterized by the presence of a large number of communications between arteries and veins. The etiology of congenital arteriovenous malformations is unknown. Acquired AVFs are the most common and account for 75-80% of all renal AVFs. Idiopathic renal AVFs—less than 3%—have characteristics of acquired fistulas and may be caused by a renal artery aneurysm. Idiopathic AVFs are thought to arise from spontaneous vessel erosion or rupture of the renal artery into the nearby renal veins.
Clinical case
Patient K., 28 years old, was hospitalized in the department of vascular surgery of the City Clinical Hospital No. 2 with suspected arteriovenous malformation of the right kidney and aneurysmal dilatation of its artery.
From the anamnesis it is known that in August 2016 the patient was hospitalized at the hospital at her place of residence with pain in the right lumbar region.
MSCT angiography performed at the place of residence diagnosed a giant cyst of the upper pole of the right kidney (70×80 mm), as well as aneurysmally dilated artery and vein in the renal hilum (Fig. 1). In the same zone, blood was discharged from the renal artery into the veins and then into the inferior vena cava. From the anamnesis it is known that no pathologies were previously detected in the urinary, cardiovascular, respiratory and gynecological systems. In 2014, an operation was performed - a caesarean section.
Rice. 1. Arteriovenous fistula of the renal artery
with a venous aneurysm at the hilum of the right kidney.
The epidemiological and hereditary history is not burdened. The patient does not smoke. Constitutionally developed correctly. The musculoskeletal system is without features. There is no peripheral edema. Blood pressure 120/70 mm Hg. pulse 70 beats/min, rhythmic.
The abdomen is soft, painless on palpation, peristalsis can be heard. In the right hypochondrium there is a formation 70x80 mm - mobile, painless on palpation, with pronounced systolic tremor.
The liver is not enlarged, tapping on the lumbar region is painless. The pulsation of peripheral arteries is distinct. Clinical and biochemical blood parameters are within normal values.
Additional selective angiography of the right renal artery, carried out in the department, revealed its expansion to 11 mm and accelerated AV discharge of blood through the dilated and tortuous veins of the kidney into the vena cava. The kidney is descended, the upper pole is at the level of L2–L3. Kidney size 80×135×84 mm (Fig. 2).
Rice. 2. Selective angiography right renal artery.
Dynamic angionephroscintigraphy showed a violation of the filtration and evacuation functions of the right kidney. Static scintigraphy revealed uneven distribution of the radiopharmaceutical in the right kidney and its deformation. There were signs of preservation of functioning parenchyma.
The data from the examinations did not allow us to accurately determine the type of pathology: AV malformation, AV fistula, venous or arterial aneurysm. A decision was made to perform surgical treatment - revision of the vessels of the renal system with possible nephrectomy if reconstruction is not possible.
On November 1, 2016, the patient underwent surgery to eliminate an arteriovenous fistula of the right renal artery. Under endotracheal anesthesia, a Rob incision was made on the right, and the right kidney with a huge cavity formation in the upper pole was isolated retroperitoneally. The formation measuring 300x200x150 mm is filled with transparent liquid (Fig. 3, A). A urologist is invited to the operating room. The formation was regarded as a cyst. After opening, about 500 ml of clear yellowish liquid was evacuated. The walls of the cyst are excised and coagulated. Next, the renal artery with branches and an additional varicose renal vein extending from the posterior part of the renal hilum are identified (Fig. 3, B). During the inspection, a characteristic “spinning top” noise was found in the area of one of the branches of the renal artery of the 2nd order. In the same area, a small “bulging” of a vein with a diameter of 1 cm was noted, in which a “swirl” of scarlet blood was visible. When this arterial branch was blocked, the noise stopped. The renal artery and veins are compressed. When opening the area of the “bulging” vein, the main venous aneurysm was visualized, which occupied almost the entire area of the renal hilum (Fig. 3, C). During the control blood flow through the arteries, the flow of blood into the venous aneurysm was carried out only through one arteriovenous fistula from the second-order branch of the renal artery. After cutting off from the aneurysm, the artery was sutured with a 6/0 Prolene thread, and blood flow and outflow through the veins were restored through it (Fig. 3, D). The renal artery clamping time is 10 minutes. Upon further inspection of the cavity of the venous aneurysm, no arterial blood flow was observed. There was a small supply of venous blood in the area of the accessory renal vein. The exposed cavity of the venous aneurysm was partially sutured and sutured with 5/0 Prolene thread. The outflow through the main vein is good. The outflow of blood through the accessory vein was not determined, and therefore it was ligated and cut off from the kidney and the inferior vena cava. Hemostasis. The kidney is fixed. Drainage of the retroperitoneum and pelvis.
Rice. 3. Stages of the operation.
Blood pressure and diuresis were monitored throughout the operation. The operation time was 240 minutes. The duration of anesthesia is 370 minutes.
The total blood loss was 300 ml. Diuresis – 3,200 ml. The postoperative period was uneventful, diuresis was maintained. Histological examination revealed no evidence of a malignant or proliferative process. Renal scintigraphy was performed on the 8th day after surgery. Positive dynamics of drug accumulation were noted. The patient was discharged in satisfactory condition on the 10th day after surgery.
Control scintigraphy after 1 month revealed positive dynamics of drug accumulation in the kidney. No signs of obstruction were found.
3 months after surgery, repeated MSCT angiography of the right kidney revealed no signs of arterial blood discharge into the inferior vena cava (Fig. 4).
Rice. 4. Control MSCT angiography and urography.
The endovascular method with selective embolization of the AVF, which is considered an alternative to open surgery, has become widely used in the diagnosis and treatment of renal AVF. However this method effective for congenital fistulas with intrarenal localization and in the described case was not applicable.
A limitation of the use of the endovascular technique is that the large size of AV fistulas may lead to migration of embolic material, leading to emergency surgery.
Video presentation
LITERATURE/REFERENCES
- Glybochko P.V. Alyaev Yu.G. Kondrashin S.A. and others. Endovascular methods of diagnosis and treatment of congenital arteriovenous fistulas of the kidney. Medical Bulletin of Bashkortostan. 2011; 2: 224-227.
- Yoon J.W. Koo J.R. Baik G.H. et al. Erosion of embolization coils and guidewires from the kidney to the colon: delayed complication from coil and guidewire occlusion of renal arteriovenous malformation. Am. J. Kidney Dis. 2004; 6: 1109-1112.
- Mizuno A. Morita Y. et al. Transcatheter embolization of high-flow renal arteriovenous fistula using n-butyl cyanoacrylate accompanied by delayed hydronephrosis. Intern. Med. 2016; 55: 3459-3463.
- Ozaki K. Kubo T. Hanayama N. et al. High-output heart failure caused by arteriovenous fistula long after nephrectomy. Heart Vessels. 2005; 20: 236-238.
- Nagpal P. Bathla G. Saboo S.S. et al. Giant idiopathic renal arteriovenous fistula managed by coils and amplatzer device: Case report and literature review. World J. Clin. Cases. 2016; 4: 364-368.
- Nawa S. Ikeda E. Naito M. et al. Idiopathic renal arteriovenous fistula demonstrating a huge aneurysm with a high risk of rupture: report of a case. Surg. Today. 1998; 28: 1300-1303.
- Giavroglou C.E. Farmakis T.M. Kiskinis D. Idiopathic renal arteriovenous fistula treated by transcatheter embolization. Acta Radiol. 2005; 4: 368-370.
Ovarian cyst
General information about ovarian cysts
Follicular cysts and cysts corpus luteum refer to formations of a functional nature, formed in the ovarian tissue itself and directly related to the cyclic changes occurring in it. The formation of a follicular cyst occurs at the site of an unruptured follicle, and corpus luteum cysts occur at the site of a non-regressed corpus luteum of the follicle. Pathological cavities in these types of ovarian cysts are formed from the membranes of the follicle and the corpus luteum, respectively. Their origin is based on hormonal disorders. Usually follicular cyst ovary and corpus luteum cyst do not reach significant sizes and can disappear on their own as the secretion in them resolves and the cystic cavity subsides.
Paraovarian cysts arise from the supraovarian appendages without involving ovarian tissue in the process. Such ovarian cysts can reach gigantic sizes. Endometrioid cysts are formed from particles of the uterine mucosa (endometrium) during its pathological focal growth on the ovaries and other organs (endometriosis). The contents of endometriotic ovarian cysts are old blood.
Mucinous ovarian cysts are often multilocular and filled with thick mucus (mucin) that is produced by the inner lining of the cyst. Endometrioid and mucinous ovarian cysts are more prone to degeneration into malignant neoplasms. Congenital ovarian cysts include dermoid cysts. formed from embryonic rudiments. They contain fat, hair, bones, cartilage, teeth and other fragments of body tissue.
Most ovarian cysts long time have no pronounced clinical manifestations and are often detected during preventive gynecological examinations. In some cases (increase in size, complicated course, hormonal secretion, etc.), ovarian cysts can manifest themselves with the following symptoms:
An increase in abdominal circumference or its asymmetry may be associated with both a large ovarian cyst and ascites (accumulation of fluid in the abdominal cavity).
Hormonally active ovarian cysts cause menstrual irregularities - irregular, heavy or prolonged menstruation, acyclic uterine bleeding. When tumors secrete male sex hormones, hyperandrogenization of the body may occur, accompanied by deepening of the voice, male-type hair growth on the body and face (hirsutism), and enlargement of the clitoris.
Causes of ovarian cysts
Complications of ovarian cysts
An ovarian cyst is most often a mobile formation on a stalk. Torsion of the pedicle of the cyst is accompanied by a violation of its blood supply, necrosis and symptoms of peritonitis (inflammation of the peritoneum), which is clinically manifested by the picture of an “acute abdomen”: sharp abdominal pain, increased body temperature up to 39°C, vomiting, tension in the muscles of the abdominal wall. Possible torsion of the cyst along with fallopian tube and ovary. In these cases, emergency surgery is required, during which the issue of the volume of necessary surgical intervention is decided.
Diagnosis of ovarian cysts is carried out based on the following methods:
The choice of treatment tactics for ovarian cysts depends on the nature of the formation, severity clinical symptoms, the patient’s age, the need to preserve reproductive function, the risk of developing a malignant process. Waiting tactics and conservative treatment possible with a functional nature and uncomplicated course of the ovarian cyst. In these cases, monophasic or biphasic therapy is usually prescribed. oral contraceptives during 2-3 menstrual cycles, a course of vitamins A, B1, B6, E, C, K, homeopathic treatment.
In some cases, diet therapy is indicated, physiotherapy. acupuncture. treatment with mineral waters (balneotherapy). In the absence of a positive effect from conservative therapy or when the size of the ovarian cyst increases, it is indicated surgical intervention– removal of the formation within healthy ovarian tissue and its histological examination.
In recent years, the laparoscopic method has been widely used in the surgical treatment of ovarian cysts. Laparoscopy is usually not used if it is reliably known that the malignancy of the process in the ovaries. In this case, an extended laparotomy (abdominal surgery) is performed with emergency histological examination of the tumor.
Prognosis after treatment of an ovarian cyst
LAPAROSCOPIC REMOVAL OF A GIANT KIDNEY CYST
13. Nieh P.T. Bihrle W. 3rd. Laparoscopic marsupialization of massive renal cyst // J Urol. – 1993 Jul. – No. 150 (1). – R. 171–3.
14. Singh I. Sharma D. Singh N. Retroperitoneoscopic deroofing of a giant renal cyst in a solitary functioning hydronephrotic kidney with a 3-port technique // Surg Laparosc Endosc Percutan Tech. – 2003 Dec. – No. 13 (6). – R. 404–8.
15. Youness A, Abdelhak K, Mohammed F. et all. Remission of hypertension after treatment of giant simple renal cyst: a case report // Cases J. – 2009. – No. 2. – 9152 rub.
A kidney cyst is a common benign kidney lesion and occurs in at least 24% of people over 40 years of age and in 50% of people over 50 years of age. Due to the development of diagnostic methods, the detection of kidney cysts throughout the world is increasing.
Renal cysts may obstruct the collecting system, compress the renal parenchyma, or cause spontaneous hemorrhage, inducing pain and hematuria. Additionally, they can become infected or can cause obstructive uropathy and hypertension. Not so long ago, before endoscopic surgical methods began to be widely used in medicine, a patient with a kidney cyst was mainly offered dynamic monitoring of the size of the cyst. According to indications, open surgery was performed, which was not always feasible due to concomitant pathology.
Bosniak (1997) developed a convenient classification that divides renal cysts into categories according to the degree of their possible malignancy:
Category II - benign, minimally complicated cysts, which are characterized by the appearance of septations, calcium deposition in their walls, infected cysts, and hyperdense cysts. This category of cysts almost never becomes malignant and requires dynamic ultrasound monitoring.
Category III - This group is more uncertain and tends to become malignant. Radiologic features include ill-defined contour, thickened septa, and patchy areas of calcium deposition for which surgical treatment is indicated.
Category IV - formations have a large liquid component, an uneven and even lumpy contour and, most importantly, in some places they accumulate a contrast agent due to the tissue component, which indirectly indicates malignancy.
Indications for surgery for a kidney cyst are: compression of the urinary tract by the cyst, compression of the kidney tissue by the cyst, infection of the cyst cavity and the formation of an abscess, rupture of the cyst, large size of the cyst, pain symptom and malignant hypertension. Most patients with cysts larger than 3 cm begin to experience pain sooner or later. Giant kidney cysts measuring more than 15 cm are a rather rare observation in practice.
Hulbert in 1992 was the first to perform and describe the technique of laparoscopic cystectomy. This technique allows the removal of solitary, multiple, peripelvical and bilateral renal cysts in a single operation. Today, cystectomy is performed using laparoscopic and retroperitoneoscopic methods. The laparoscopic approach is a minimally invasive method that allows decompression of cysts under direct visual control. Laparoscopy is an effective treatment for patients with autosomal dominant polycystic kidney disease who experience pain symptoms (Bosniak II and III).
In the literature available to us, we found only a few cases of laparoscopic removal of giant renal cysts. The case we presented is a rather rare observation in urological practice and, in our opinion, will arouse interest among colleagues.
Goal of the work - to clearly demonstrate the effectiveness of the laparoscopic method in the surgical treatment of giant renal cysts.
Material and research methods
Patient X., 57 years old, was admitted to the urological clinic of the Azerbaijan Medical University in November 2010 with complaints of constant dull, aching pain in the right lumbar region. According to the patient, the disease began approximately 4 months before hospitalization. Upon admission, the general condition was satisfactory. From the cardiovascular system, coronary heart disease and atherosclerotic cardiosclerosis are noted. Indicators of general and biochemical blood tests are within normal limits. Ultrasound examination (US) and contrast computed tomography (CT) revealed no pathological changes in the abdominal organs. The size, thickness of the parenchyma and the functional state of the kidneys are satisfactory. In the area of the anterior, posterior segments and upper pole of the kidney, a solitary cyst measuring 16.5×12.5×10 cm is determined (Fig. 1). The cyst has no adhesions to the right lobe of the liver. Four cysts measuring 1.5×1.5 are identified in the left kidney; 1.8×1.7; 3.1×2.4; 5.4×5.0 cm (Fig. 2). Abdominal and retroperitoneal lymph nodes are unchanged. The patient was diagnosed with a giant cyst of the right kidney, multiple cysts of the left kidney, coronary heart disease, atherosclerotic cardiosclerosis.
Rice. 1. Ultrasound of the patient before surgery. Giant cyst of the right kidney. The kidney is not visualized due to the large size of the cyst.
The patient underwent laparoscopic transperitoneal removal of a giant cyst of the right kidney.
The patient is positioned in the lateral decubitus position at an angle of 45 degrees. Given the location of the cyst, the first port (11 mm) was placed 2 cm above and distal to the umbilicus and a pneumoperitoneum was created. Next, two more ports (13 and 5 mm) were installed under laparoscopic control. After separating the adhesions in the abdominal cavity, the peritoneum was dissected along the posterior wall of the abdominal cavity along the white line of Toldt to the hepatic flexure of the colon, then the colon was separated from the tissues of the retroperitoneal space and Gerota's fascia was exposed. The outer surface of the cyst was completely mobilized from the surrounding tissue (Fig. 3).
Rice. 2. Computed tomography of the patient before surgery. Giant cyst of the right kidney, kidney tissue is pushed under the liver and towards the spine
Rice. 3. Mobilized giant renal cyst
Next, it was opened in a small area and aspiration of the contents, which amounted to 1.6 liters. To excise the walls of the cyst, a device for dosed electrothermal tissue ligation “Liga sure” and endoscissors with coagulation were used. After complete excision of the cyst edges, a drainage tube was installed (Fig. 4). The duration of insufflation was 65 minutes, the duration of the operation was 75 minutes. Intraoperative bleeding - 20 ml. Hospitalization time 2 days. On the first day, discharge from the drainage tube amounted to 40 ml; on the second day, no discharge was observed. The drainage tube was removed, and the patient was discharged in satisfactory condition. The result of pathohistological examination: the walls of the excised cyst consist of fibrous tissue.
Research results and discussion
Laparoscopic surgery for kidney cysts is a modern and low-traumatic method for radical removal of cysts. This method allows any intervention on the cyst, including nephrectomy. In case of intraparenchymal renal cyst, when there is a high risk of damage to the renal cavity system, the patient must be warned before laparoscopic surgery about the possibility of expanding the scope of the intervention. This may be cyst enucleation, kidney resection, or nephrectomy.
Rice. 4. Patient after surgery
Naturally, a kidney cyst is not always an indication for surgical intervention or even active action. Most often, if the cyst does not bother the patient, and even more so if he did not even suspect its presence, dynamic observation is sufficient. This means that every six months to a year the patient must be examined by a doctor and undergo research (usually an ultrasound of the kidneys).
The wall of the cyst consists of a connective tissue capsule lined with squamous and cuboidal epithelium, in the vast majority of cases with chronic inflammation. In addition, in some patients, histological examination reveals muscle fibers in the cyst wall. The fibrous capsule of the cyst is lined from the inside with epithelium resembling endothelium or mesothelium, and degenerated nephrons, smooth muscle fibers and chronic inflammatory cells are found in the collagen tissue of the cyst wall. The epithelium of the cyst may be discontinuous. In many patients, the epithelial lining of the cyst is absent. In some places of the capsule the epithelium disappears or atrophies, while in others, on the contrary, it has 2-3 layers of cells. In some cases, lime deposits, embryonic inclusions, remnants of kidney and even adrenal tissue are observed in the thickness of the cyst wall. The deposition of lime in the walls of the cyst indicates its “old” age.
How transparent and pure the consistency of the liquid contents of the cyst during aspiration is, the greater the likelihood of a benign process in the kidney. With giant cysts, the presence of a malignant process in the kidney has not been described in the literature. In the patient we presented, during aspiration, we observed clean and transparent liquid, the volume of which was more than 1600 ml, without the presence of hemorrhages and signs of inflammation. The size of the cyst, the structure of its wall, and the consistency of the contents did not cause us to suspect the presence of a malignant process during the operation, which was also confirmed by pathohistological examination data.
Laparoscopic resection of a kidney cyst is an effective intervention with a low number of complications and rapid rehabilitation of patients. Emerging intraoperative complications can be eliminated without conversion if the operating surgeon has sufficient skills and appropriate equipment in the operating room. With sufficient experience and skill, the retroperitoneoscopic approach is less invasive and minimizes (though does not eliminate) the risk of internal organ injury. But in this case, we performed surgical intervention using a transperitoneal approach. We made this decision based on the gigantic size and location of the cyst. The transperitoneal approach allowed us to completely mobilize the extrarenal areas of the cyst from the surrounding tissues; no intraoperative complications were observed.
The success of laparoscopic ablation of a renal cyst is relief of symptoms, observed on average in 97% of patients and the absence of signs of recurrence of the cyst in 92% of patients, which is superior in effectiveness to other methods of surgical treatment.
Our patient's main complaints were constant dull and intermittent sharp pain in the right side, especially occurring when lying on the right side. After surgery, the patient completely disappeared from pain, his general condition was satisfactory a day later, and after a few days he returned to active life. The patient was under observation; studies carried out one year after the operation revealed satisfactory function of the right kidney, absence of pyelectasia, hydronephrosis and signs of cyst recurrence. The patient was in perfect health and had no complaints.
Conclusion
An analysis of the world literature and our experience in treating patients with renal cysts have shown that laparoscopic and retroperitoneoscopic resection of renal cysts is currently considered a safe and effective treatment method.
Laparoscopy allows the surgeon to take a minimally invasive approach to evaluate and treat this category of renal pathology. The cyst as a whole can be completely examined under direct visual control and excised. In addition, decortication or marsupialization can be performed without subjecting the patient to open surgery. This minimally invasive approach not only has diagnostic and therapeutic benefits, but also shortens postoperative morbidity and patient recovery compared to traditional open surgery approaches.
The case we presented once again confirms the opinion that using laparoscopic access it is possible to remove a kidney cyst of any size and location. Marsupilization of giant kidney cysts using laparoscopic techniques is the optimal and least invasive method of surgical treatment.
Reviewers:
Dzhamalov F.G. Doctor of Medical Sciences Associate Professor, Department of Surgery, Faculty of Pediatrics, Azerbaijan Medical University, Baku;
Abdullaev K.I. Doctor of Medical Sciences professor, director of the Urological Center LLC, Baku.
