Clinical utilization of ureteroscope in the management of kidney cystic lesions

Zou Min; Li Wei; Xiao Minhui; Yang Hua; Shen Jie; Zhang Zhuorui; Xu Wanchao; Ma Puneng

Abstract：Objective:To establish the individualized surgical approaches for hol miumlaser and incision drainage with ureteroscope according to the features of kidney cystic lesions ,and investigate the value and clinical application prospectofureteroscopeinthe managementofkidneycysticlesions.Methods:FromMar.2008toDec.2013,70ca-ses of kidneycysticlesions weresubjectedto minimallyinvasivetunnel byusingholmiumlaserandincisiondrainage. For32casesofperipheralrenalcysts,thecysts werelocatedinthefrontofandventraltotherenalpelvis whichwas pushedtothedorsalsurfacein15cases,andthesurgicalapproachfromskintorenalpelvisandthentocyst wascho-sen;and those behind and dorsal to the renal pelvis which was pushed to the ventral surface in 17 cases ,and the sur-gicalapproachfromskintocystandthentorenalpelviswaschosen.For38casesofparapelviccysts,therewere18 casesofcystslocatedintheupperpoleofthekidney,andthesurgicalapproachfromurethratorenalpelvisandthen tocyst withureteroscope waschosen;there were20casesofcystslocatedinthe middleandthebottomofthekid-ney,andthesurgicalapproachfromurethratorenalpelvisandthentocystwithflexibleureteroscopewaschosen. Thecysticdiameterswerefrom4.5to7.0cmwiththeaverageof5.75cm.Forty-ninecasescomplainedofpain symptomsontheloinandback.Twenty-onecaseshavingnosymptoms werepresentedinphysicalexamination.All the cases were diagnosed as renal cysts undergoing B ultrasound ,I UV,CT and MRI preoperatively .Double J stent was placed post-operation .Results:All the operations were successfully carried out .The operative ti me was fro m 30 to90 minwiththeaverageof60 min.Theintraoperativebloodloss was5to100 mLwiththeaverageof52.5 mL. There were no conversions to open surgery,vascular injury and accidental injury.Urethral catheter ,nephrostomy tube and double J tube were pulled out 2 days ,5 to 7 days and 2 months after the operation respectively .The nephr-ostomyhealedafter24handhadnourinaryfistulaandextravasation.Thehospitalstaywas5to9days withtheav-erageof7days.Duringthefollow-upperiodof3to24 months,BultrasoundorCTexaminationrevealedthat68ca-ses had no recurrence and only t wo patients had a recurrence with the cystic dia meter less than 2 .0 c m.Ureteroscopy confir med cystic incision drainage closed again .Conclusions:The individualized surgical approach according to the fea-turesofkidneycysticlesionsbyusingholmiumlaserandincisiondrainage withureteroscopeisanewminimallyinva-sive method withsafety,efficiency,lessinjury,andlowrecurrence.It'stheexpandof ureteroscopyandhas moread-vantages over other treat ments .