Other Urological Conditions |

Renal Cyst

• The kidneys are the most common organ in the body to develop cysts and occur in 50% of the population older than 50.
• A simple cyst may be single or multiple, unilateral or bilateral and can range from a few mm to several cm in diameter.
• Most simple cysts are found incidentally on ultrasound or renal imaging studies are asymptomatic and require no treatment.
• Occasionally large cysts may cause pain due to cyst wall distention, intra-cystic bleeding or obstruction of the collecting system and require treatment.

Treatment options for symptomatic simple renal cysts:

• Open surgery may include nephrectomy, decortication or marsupialization of the cyst.
• Laparoscopic cyst ablation – transabdominal or retroperitoneal approach.
• Only lesions that meet the ultrasound or CT criteria for simple cysts should be approached laparoscopically. There could be a small chance of malignancy therefore the cyst wall should be inspected for tumour and sent for histology. Tumour seeding is a potential disadvantage.
• Percutaneous aspiration

Laparoscopic cyst ablation

Pelvi-ureteric junction obstruction (PUJ obstruction)

Idiopathic PUJ obstruction

• More common in men
• Affects left kidney more often than right
• 10% cases are bilateral
• Cause is unknown but important factors may be: abnormal lower pole vessels; persistant foetal urothelial fold

Clinical features

• Usually presents in adolescence or early adult life
• Presenting symptom may be loin pain - worse after alcohol
• In late cases a renal mass may be palpable
• Haematuria is an uncommon feature
• 10% develop UTIs (urinary tract infection) and 3% renal colic (pain)

Investigation

• Diagnosis can be confirmed by ultrasound
• IVU or retrograde ureterogram show a classical appearance
• Isotope renography allows assessment of percentage of renal function

Surgical Intervention for PUJ Obstruction

If the transition from the renal pelvis to the ureter is narrow, the urine will not drain easily and backs up causing dilatation of the collecting system proximal to that point and enlargement of the renal pelvis. This dilatation of the collecting system is referred to as hydronephrosis.

The aims of treatment are to:

• Relieve symptoms
• Preserve renal function

This can be achieved by a pyeloplasty. If severe renal impairment (<20% function) a nephrectomy may be required. Both pyeloplasty or nephrectomy (removal of kidney) can be achieved by open or laparoscopic method.

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