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Diagnosis and long-term outcome of renal cysts after laparoscopic partial nephrectomy in children
Ciro Esposito1, Maria Escolino1, Bernardita Troncoso Solar2
1Division of Pediatric Surgery, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Insights
Post-operative simple cysts are common after laparoscopic partial nephrectomy (LPN) in children, appearing in about 50% of cases. These asymptomatic renal cysts can be safely managed with conservative observation and periodic ultrasounds.
Area of Science:
- Pediatric Surgery
- Urology
- Radiology
Background:
- Laparoscopic partial nephrectomy (LPN) is a common procedure in pediatric urology.
- Post-operative imaging surveillance is crucial for monitoring outcomes.
- The natural history of cystic lesions after pediatric LPN requires further documentation.
Purpose of the Study:
- To document the imaging follow-up of pediatric patients who underwent LPN.
- To investigate the natural history and characteristics of cystic lesions that develop after LPN.
Main Methods:
- Retrospective review of ultrasonography (US) imaging reports from 125 children who underwent LPN between 2005 and 2015.
- Analysis of cyst appearance, size, and changes over a mean follow-up of 4.2 years.
- Correlation of cyst formation with surgical approach and clinical outcomes.
Main Results:
- Post-LPN cystic lesions were identified in 48.8% of patients, with most being simple, anechoic cysts.
- The mean cyst diameter was 3.3 × 2.8 cm.
- Of the identified cysts, 21.3% resolved, 42.6% remained stable, 27.8% decreased in size, and 8.3% enlarged. Most cysts were asymptomatic and did not require re-intervention.
Conclusions:
- Simple cysts at the operative site are a frequent finding after pediatric LPN, likely representing seromas.
- There was no correlation between cyst formation and surgical technique or clinical outcomes.
- Conservative management with periodic US surveillance is appropriate for asymptomatic renal cysts following LPN.
Objective:
To document the imaging follow-up of laparoscopic partial nephrectomy (LPN) in children and to investigate the natural history of cystic lesions following LPN.
Patients And Methods:
We reviewed the ultrasonography (US) imaging reports performed during the follow-up of 125 children (77 girls, 48 boys; mean age 3.2 years) who underwent LPN in two centres of paediatric surgery in the period 2005-2015.
Results:
A transperitoneal approach was adopted in 83 children and a retroperitoneal approach in 42. The mean follow-up was 4.2 years. At US, an avascular cyst related to the operative site was found after 61/125 procedures (48.8%). As for their appearance, 53/61 cysts were simple and anechoic, and eight of the 61 cysts appeared septated. The mean diameter of the cysts was 3.3 × 2.8 cm. As for their course, 13/61 cysts (21.3%) disappeared after a mean of 4 years, 26/61 (42.6%) did not significantly change in dimension, 17/61 (27.8%) decreased in size, and only five of the 61 cysts (8.3%) enlarged. The cysts were asymptomatic in 51 children (83.6%), while they were associated with urinary tract infections (UTIs) and abdominal pain in the remaining 10; none required a re-intervention.
Conclusions:
The US finding of a simple cyst at the operative site after LPN is common during follow-up, with an incidence of ~50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There was no correlation between cyst formation and type of surgical technique adopted. As there was no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodic US evaluations.
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