Treatment goals for polycystic disease
In autosomal dominant polycystic disease, the kidneys gradually enlarge with hundreds of cysts, causing dull pain, hypertension, and decreased function. Puncture of the 3–5 largest cysts (more than 5–7 cm) relieves tension in the kidney capsule and pain for months; when the cyst suppurates, aspiration is performed with the administration of an antibiotic. The procedure is repeated as the cysts grow. Radical operations for polycystic disease are not indicated; the basis of treatment is blood pressure control, diet and observation by a nephrologist; in case of terminal renal failure, the issue of dialysis and transplantation is resolved.
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.
