How is sclerotherapy performed?
The patient lies on his stomach or side; After local anesthesia, under ultrasound guidance, a needle is inserted into the cyst, the contents are completely aspirated and sent for cytology. Then a sclerosant is injected into the cavity in a volume of 10–25% of the volume of the cyst, exposure is 10–20 minutes with body turns to contact the entire wall, after which the solution is removed. For cysts larger than 8–10 cm, the sclerosant is reintroduced or drainage is left for 1–2 days. After 1–2 hours of observation, the patient goes home. Ultrasound monitoring after 3 and 12 months; in case of relapse, repeated puncture or laparoscopic excision is possible.
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.
