Management Of Bilateral Renal Cystic Diseases Simultaneously

Background and objectiveRenal cystic diseases are very common in adult people. Among them, autosomal dominant polycystic kidney disease (ADPKD) is an important one and always bilateral. These kidneys are usually much enlarged. Their surfaces are studded with cysts of various sizes. Clinical findings include pain over one or both kidneys, hematuria, infection and renal function failure. Decompression of cysts is believed to relieve the symptoms and slow down the deterioration of renal function. With the experience of bilateral cysts decompression through one intraperitoneal incision, we discuss the characters and advantages of this procedure. And further, we extend the topic to the values and indication of surgical treatment for ADPKD.Simple renal cysts are major form of renal cystic diseases with no symptoms in most cases. With the increasing use of imaging examinations such as ultrasonography and CT, the possibility of detection of simple renal cysts has been raised . Symptomatic renal cysts were treated by percutaneous or open surgery before. Recently, laparoscopic decortication is used for the treatment by transperitoneal or retroperitoneal access. In this article we introduce our experience of transperitoneal laparoscopic surgery for bilateral simple renal cysts simultaneously.MethodsBetween January 2001 to January 2004, 15 cases of ADPKD were admitted. 8 cases complained of dull renal angle pain or flank pain. Hypertention is present in 10 cases. Hematuria is present in 2 cases. Renal function: BUN 5.8-10.8 mmol/L, Cr 71-185 mol/L. Size of the kidneys: 8cmx 12cmx8cm~ 28cmx20cmx25cm. CT scanning revealed that kidneys were composed of countless cysts with different sizes. All the 15 cases of ADPKD underwent open renal cysts decompression bilaterally with one incision at the midline of the abdominal wall, simultaneously.During the same time period, 9 cases of bilateral simple renal cysts were admitted, 4 of them were incidentally found, 5 cases complained dull renal angle pain. Diameter of cysts: 3.8-10.7cm. CT index: 5.0~10.3Hu. Based on CT scanning, ultrasonography. IVP or MRI, the cysts were not connected with the collecting systems. Cysts decortication through transperitoneal laparoscopy were performed on 9 cases of simple bilateral renal cysts. Four ports technique was used for the procedure.ResultAll operations for ADPKD were successful without any serious complication. Pain was relieved in 8 cases. Hematuria disappeared in 1 case. Blood pressure decreased in 7 cases. Renal function of 13 cases of ADPKD became better 14 days after operation compared with that preoperatively. 9 cases of simple bilateral cysts decortication through transperitoneal laparoscopy were successful without any complication. Symptoms were relieved and recovery time was short.ConclusionThe techniques of ADPKD decompression bilaterally with one incision simultaneously and transperitoneal laparoscopic decortication of simple bilateral renal cysts are mini-invasive and valuable.