When to choose open access
Through a mini-lumbotomy of 6–8 cm, the surgeon identifies the kidney in the cyst area, opens it, empties it, excises the free wall along the border with the parenchyma and coagulates the bed; in suspicious areas, urgent histology is performed, and if the tumor is confirmed, the operation is expanded to partial nephrectomy. The drainage is removed after 1–2 days. Open access is safer than laparoscopy for purulent cysts, adhesions and obesity, as well as for cysts located deep in the pelvis and vessels. Recurrences after complete excision are less than 5%.
When should a kidney cyst be treated?
- cyst more than 5 cm or rapidly growing;
- lower back pain, feeling of heaviness;
- compression of the pelvis or ureter with impaired urine outflow;
- increased blood pressure associated with the cyst;
- suppuration or hemorrhage into the cyst;
- complex cyst (Bosniak III–IV) - excision with histology to exclude cancer.
Simple cysts up to 4-5 cm without symptoms do not require treatment - an ultrasound scan once a year is enough.
Puncture or laparoscopy
Puncture with sclerotherapy is an outpatient procedure under local anesthesia with an effectiveness of 70–85%; Suitable for simple cysts with easy access. Laparoscopic excision of the cyst wall gives a lasting result of 95% and allows the wall to be examined histologically; indicated for large, recurrent, parapelvic and complex cysts. For polycystic cysts, puncture or laparoscopic decortication of several of the largest cysts is performed to reduce pressure and pain.
