Flexible ureteroscopic management of symptomatic renal cystic diseases

Parapelvic renal cysts are more likely to be symptomatic compared with that of simple peripheral renal cysts, and their treatment remains challenging. This study aimed to assess the feasibility and safety of flexible ureteroscopy in managing symptomatic endogenous renal cystic diseases.

Thirty-five patients with symptomatic endogenous renal cystic diseases were treated by ureteroscopic unroofing and drainage into the collecting system. Surgical procedure, patient's outcome, and postoperative complications were retrospectively evaluated.

Ureteroscopic unroofing and drainage were successful in 35 patients without conversion to open surgery. For patients with successful surgery, the mean operation and hospitalization times were 25.38 ± 3.71 min and 3.01 ± 0.57 d, respectively, with a curative standard rate of 74.3% (26/35). Three patients experienced Clavien grade I and II complications but no serious perioperative complications occurred. During the follow-up period averaging 36 mo, no cysts were detected in 74.3% of patients (26/35); noticeable relief was observed in four patients showing a simple renal cyst (diameter <2 cm). In five patients who presented with polycystic kidneys, the renal volume was decreased by 93.76 ± 7.38 mL per side, on average, compared with pretreatment values. Pain was relieved in all 30 patients with renal cysts. Hydronephrosis disappeared in all 15 patients diagnosed with this condition at presentation. No secondary cyst lesions (such as infection, hematoma formation, and solid cystic changes) occurred.

The transurethral flexible ureteroscopic incision and drainage for symptomatic endogenous renal cystic diseases has multiple advantages such as minimal trauma, rapid recovery, and a definite curative effect.