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Renal Cystic Echinococcosis: Long-Term Outcomes of Percutaneous Treatment
Turkmen Turan Ciftci1, Emre Unal1, Aynur Azizova1
1Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Insights
Percutaneous treatment of renal cystic echinococcosis (CE) using WHO-classified stages shows high success rates. Tailored percutaneous techniques minimize adverse events and recurrence for effective renal CE management.
Area of Science:
- Urology
- Parasitology
- Interventional Radiology
Background:
- Renal cystic echinococcosis (CE) is a parasitic infection requiring effective treatment.
- Percutaneous techniques offer a minimally invasive approach to managing renal CE.
- Stratification by World Health Organization (WHO) cyst stages is crucial for treatment selection.
Purpose of the Study:
- To evaluate the long-term outcomes of percutaneous treatment for renal CE.
- To assess the efficacy of different percutaneous techniques based on WHO cyst staging.
- To determine complication and recurrence rates associated with these treatments.
Main Methods:
- Retrospective analysis of 34 patients with renal CE treated between 1997 and 2019.
- Classification of cysts into WHO stages: CE1, CE2, CE3a, and CE3b.
- Application of Puncture, Aspiration, Injection, Reaspiration (PAIR), standard catheterization, or Modified Catheterization (MoCaT) based on cyst stage.
Main Results:
- 100% technical success rate with percutaneous interventions.
- 97% clinical success rate with a 3% recurrence rate, successfully re-treated.
- Minimal adverse events: 3% severe bacterial superinfection and 12% mild/moderate allergic reactions.
Conclusions:
- Percutaneous treatment of renal CE is highly effective and safe when techniques are matched to WHO-defined cyst stages.
- Tailored percutaneous approaches lead to significant cyst volume reduction and low recurrence.
- This approach offers a viable, minimally invasive option for managing renal cystic echinococcosis.
Purpose:
To evaluate the long-term outcomes of percutaneous treatment of renal cystic echinococcosis (CE) stratified by cyst stages according to the World Health Organization (WHO) classification.
Materials And Methods:
Between January 1997 and February 2019, 34 patients with renal CE (18 women; mean age, 38 years) were treated with 3 different percutaneous techniques. According to the World Health Organization classification, the cysts were classified as CE1, CE2, CE3a, and CE3b. Puncture, aspiration, injection, reaspiration (PAIR) or standard catheterization was used for the dimension-based treatment of CE1 and CE3a cysts. Modified catheterization (MoCaT) was used to treat all CE2 and CE3b cysts. Technical and clinical success, complications, and reduction in cyst cavities were evaluated.
Results:
The technical success rate was 100%. PAIR, standard catheterization, and MoCaT were used to treat 12, 9, and 13 cysts, respectively. The only severe adverse event was a bacterial superinfection that occured in the cyst cavity of a patient (3%) treated with MoCaT. Four patients (12%) experienced mild/moderate periprocedural allergic adverse events and were managed conservatively. The mean length of hospital stay was 1, 5, and 7 days for patients treated with PAIR, standard catheterization, and MoCaT, respectively. The clinical success rate was 97%. In 1 of 34 cysts (3%), recurrence was detected and the cyst was successfully re-treated. During the 10.5-year follow-up period, 95% volume reduction was achieved. The median final cyst volume was 10 mL.
Conclusions:
Renal CE can be successfully treated with minimum adverse events and recurrence rates using appropriate percutaneous techniques selected according to their stages as classified according to WHO.
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