Laparoscopic decortication of symptomatic simple renal cysts: 10-year experience from one institution
Koji Shiraishi1, Satoshi Eguchi, Jun Mohri
1Department of Urology, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan. koji-shiraishi@uiowa.edu
Objective:
To assess the long-term results by symptomatic and radiological outcome of laparoscopic decortication of renal cyst, first reported in 1992.
Patients And Methods:
We retrospectively reviewed the records of 36 patients who had a total of 36 laparoscopic decortications at our institution between December 1993 and March 2004. Of these cysts, 30 were peripheral and six were peripelvic cysts; the patients were asked if they had pain or not. Changes of cyst size after decortication were determined by computed tomography and the serial changes of each cyst were evaluated as the percentage of the diameter before surgery. The relationships between radiological and symptomatic outcome or cyst location were examined.
Results:
Peri-operative morbidity was satisfactory; with a mean (range) follow-up of 67.2 (13-128) months the symptomatic and radiological success rates were 92% (33 of 36) and 81% (25 of 36), respectively. Peripelvic cysts were significantly correlated with radiological failure. Symptomatic improvement was evident by 3 months, while radiological improvement continued for up to 3-4 years after surgery. Seven asymptomatic patients with radiological failure selected a conservative follow-up.
Conclusions:
Laparoscopic decortication is safe and provides long-term satisfactory symptomatic results. The radiological improvement was slower than the symptomatic improvement and several cysts remained large, indicating some reduction in volume that was enough to improve the symptoms. This procedure is still challenging for peripelvic cysts in terms of radiological results, yet feasible for the clinical outcome.
