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Urinary Disorders

Kidney Cyst Removal

11/06/2008

Question:

I have a 5 inch cyst on my kidney that is pressing against my bladder. I was advised to have it removed. What method of removal does the least amount of damage to the kidney? I have heard that if you have it drained that it can fill back up within weeks. Thanks for your answer.

Answer:

I assume that this 5 inch cyst on your kidney is a simple cyst. Such cysts usually do not require drainage unless they are compressing on surrounding organs or causing symptoms. One of the options for this cyst would be needle aspiration under CT scan/ultrasound guidance (can be done by a interventional radiologist by inserting a needle through the skin). This can be done under local anesthesia with sedation or under anesthesia.

The radiologist would need to review the films to evaluate whether this approach is technically feasible (not all cysts are treatable this way). There is a risk of refilling of the cyst though it is difficult to know how long this can take. Sometimes the radiologist might be able to insert some special sclerosant fluid into the cyst to try and decrease the recurrence but this is also not guaranteed to prevent recurrence.

The advantage of this technique is that it is a minimally invasive outpatient procedure and will also let you know whether your symptoms are relieved with the drainage of the cyst before you move on to a more invasive procedure. You should discuss all these issues with your urologist/interventional radiologist.

The other minimally invasive technique of treating this cyst would be laparoscopic unroofing. In this technique, the outer wall (roof) of the cyst is excised (removed) and the cyst is drained. The lining of the cyst wall cavity which is left behind is then coagulated (destroyed using heat energy) in order to try and decrease the chances of recurrence. This technique can be done laparoscopically (keyhole surgery) with a hospital stay of usually 1 to 2 days. The chances of recurrence with this technique are minimal and significantly reduced in comparison to the aspiration. The postoperative recovery is faster with the laparoscopic approach than if this procedure is done with conventional open surgery (another way of doing this procedure). Once again, you will have to review the images with your urologist who will have to determine the technical feasibility of this procedure (not all cysts are treatable this way).

Both these procedures usually cause minimal damage to the kidney. The cyst wall which is removed in the surgical approach does not usually consist of any functioning kidney tissue. I hope you find this information useful. You can discuss this issue with your treating physician/urologist, who will review the different options and the risks/benefits of each option with you, based on your clinical situation and imaging findings.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati