Percutaneous treatment of simple renal cysts with sclerotherapy and extended drainage.

PURPOSE: To present the long-term results of sclerotherapy of symptomatic simple renal cysts with alcohol and aethoxysclerol followed by protracted seven-day drainage and to compare the efficacy of the two sclerosing agents used in the therapy. MATERIALS AND METHODS: Sixty-six symptomatic patients underwent percutaneous treatment with drainage and sclerotherapy of 72 simple renal cysts in a day hospital setting. The cysts were divided into two groups according to size (Group I and Group II with cyst volume smaller or larger than 600 ml respectively) for a better comparison of the results. The cysts were punctured directly under local anaesthesia with a 7 French Trocar catheter using the ''one-shot'' technique and ultrasound guidance; a pig tail catheter was then left in the cyst for the complete evacuation of the cyst fluid. Sclerotherapy was performed by injection of 95% alcohol or 3% aethoxysclerol for 40 minutes, followed by seven-day drainage. On the basis of dimensional criteria, response to treatment was defined as: recovery, partial recurrence or recurrence. RESULTS: The procedure was successful in 97.2% of the cases with regard to cyst drainage, with clinical recovery in 95.3% of the cases. Group I had 14 recoveries and no complete recurrence after either alcohol or aethoxysclerol, 2 partial recurrences with alcohol and 4 partial recurrences with aethoxysclerol; Group II had 15 recoveries, 14 partial recurrences and one complete recurrence with alcohol, and 5 recoveries, 8 partial recurrences and 2 complete recurrences with aethoxysclerol. CONCLUSIONS: The one-shot technique under ultrasound guidance prevents the risk of major complications, reduces the likelihood of failure and is inexpensive; furthermore, it significantly reduces procedure time and is better tolerated by patients. On the basis of the clinical and dimensional results obtained, percutaneous sclerotherapy of renal cysts can be recommended as the treatment of choice and as a valid alternative to laparoscopy. As for the comparison between the two sclerosing agents, alcohol has a higher cost and negative side effects, but is more effective for the treatment of larger cysts. Aethoxysclerol is less expensive and has no side effects, but tends to lead to septic complications. On the basis of our experience, we therefore recommend the use of aethoxysclerol for sclerotherapy of smaller cysts followed by a 4-day drainage. For larger cysts, we recommend repeated alcoholization and the removal of the drainage catheter after seven days.