| Objective To improve the diagnosis and treatment of parapelvic cysts andpyelogenic cysts.Methods 15 cases of parapelvic cysts and 14 cases of pyelogenic cysts during January 1992 to October 2002 were reviewed. The etiology, manifestations, diagnosis, and treatment of parapelvic and pyelogenic cysts are discussed. Results 1. The results of diagnosisUltrasonography (US), intravenous urography (IVU), Retrograde Pyelography (RGP), computer tomography (CT) and magnetic resonance imaging (MRJ) were performed for diagnosis. Their accuracy diagnosis in parapelvic cysts is 33.3%, 28.6%, 25%, 90.9%, and 50%, respectively. CT has the most value of diagnosis in parapelvic cysts. It's accuracy of diagnosis is significantly higher than US (P<0.01) and IVU (P<0.01). And their accuracy of diagnosis in pyelogenic cysts are US 28.6%, IVU 75%, RGP 100%, CT and MRI 0%. IVU and RGP are the most available methods in diagnosis of pyelogenic cysts. It's accuracy of diagnosis is significantly higher than US (P<0.01) and CT/MRI (P<0.01). 2. The results of treatment1) 5 cases of parapelvic cysts were undergone open surgery. All of them had primary healing without complication and their symptoms disappeared in perioperative time. The examination of pathology suggested that they were all simplerenal cysts with 1 case hemorrrage and 1 infection. 10 cases of pyelogenic cysts underwent open surgery. 9 cases of them had primary healing and symptoms disappeared with no complication in perioperative time. 1 patient suffered leakage of urine and was treated with double J catheter into ureter, and then recovered.2) 2 cases of parapelvic cysts had undergone laparoscopic operation. 1 case fully recovered without complication at postoperation. And the other patient underwent retroperitoneal laparoscopic marsupialization suffered leakage of urine. He was treated with double J catheter into ureter and then recovered.3) Percutaneous aspiration and sclerosis had been done on 4 cases of parapelvic cysts. 1 case recurrence was punctured again in 2 month later. It was found that the cyst had communicated with pelvis then treated with double J catheter and still in following up now. Another 3 cases have recovered well. 1 case of pyelogenic cyst was made misdiagnosis as simple renal cyst and was operated by percuterneous aspiration and sclerosis. It was been found by accompanying with lumbag, urinary irritation symptoms and hematuria because of injecting anhydrous alcohol, and it was cured by open surgery.All of these cases have been followed up for 3 months to 10 years without recurrence, hydronephrosis vanished or relieved and renal function became normal too.4) In conservative treatment group, 1 case of pyelogenic cyst was placed with double J catheter in trouble side ureter and pulled it out in 3 months with symptoms relieved. Examinedit by US again , the cyst became small and was followed up continue. Another 3 cases of pyelogenic cysts and 4 cases of parapelvic cysts did no treatment because of small cysts, atypical symptoms, or too old years. They were followed up for 14 months to 9 years by regular US examination without deterioration.Conclusions 1. The manifestations of parapelvic cysts is similar to pyelogenic cysts but all atypical, and they relate to compression and complications of cysts.2. The preliminary assessments depend on imaging examinationmainly. US, IVU, CT and RGP is the main methods of diagnosis.3. CT has the most value of diagnosis in parapelvic cysts. Andthe diagnosis of pyelogenic cysts depend on IVU and RGP mainly.4. Small cysts without serious symptoms and complications couldbe treated conservatively. Otherwise, they should be operated.5. Open surgery is the traditional management of parapelvic andpyelogenic cysts by unroofing and filling of the cavity with fat. The therapeutic efficacy is good. Ligation of the cyst neck should be done in pyelogenic cysts in order to block th... |
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