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Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst.

Egilmez H, Gok V, Oztoprak I, Atalar M, Cetin A, Arslan M, Gultekin Y, Solak O - Korean J Radiol (2007 Nov-Dec)

Bottom Line: Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography.The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group.The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey. hegilmez@cumhuriyet.edu.tr

ABSTRACT

Objective: We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts.

Materials and methods: A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography.

Results: The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group.

Conclusion: Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.

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Representative CT images of a 53-year-old male patient with a simple renal cyst.A. The simple renal cyst before aspiration.B. A 5.4-Fr pigtail catheter was inserted into the cyst.C. Contrast medium is instilled into the cyst to ensure that there was no communication with the pelvicalyceal collecting system, to exclude any leakage from the puncture site into the retroperitoneal cavity and to determine the presence of extravasation.D. The cyst disappeared after successful ethanol sclerotherapy.
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Figure 1: Representative CT images of a 53-year-old male patient with a simple renal cyst.A. The simple renal cyst before aspiration.B. A 5.4-Fr pigtail catheter was inserted into the cyst.C. Contrast medium is instilled into the cyst to ensure that there was no communication with the pelvicalyceal collecting system, to exclude any leakage from the puncture site into the retroperitoneal cavity and to determine the presence of extravasation.D. The cyst disappeared after successful ethanol sclerotherapy.

Mentions: The sclerotherapy was performed under CT guidance on an outpatient basis. The patients were placed in the prone position and local anesthesia was achieved with 2% lidocaine hydrochloride that was applied to the puncture site. The patient was given nothing by mouth for 4-8 hours prior to the procedure. Prophylactic antibiotics were administered 60 minutes prior to the procedure and they were continued for at least 24 hours after the procedure. For all the patients, their coagulopathies were corrected prior to the procedure to decrease the chance of developing a perirenal hematoma or renal hemorrhage. Patients with bleeding tendencies, including those who were taking anticoagulants, did not undergo sclerotherapy until their clotting parameters were brought within normal limits, when possible. A pigtail catheter 5.4-Fr (PBN Medicals, Denmark) was inserted with using a trocar-catheter system under CT guidance (Figs. 1A, B). The cyst fluid was aspirated as completely as possible and it was sent to the laboratory for cytologic and biochemical examination. The total amount of the aspirated fluid was measured to record the cyst's volume. The cyst was then filled with a half-and-half mixture of water-soluble contrast medium (Telebrix 35 [350 mg iodine/ml], Guerbet Laboratories, Aulnaysous-Bois, France) with normal saline. For patients who were undergoing sclerotherapy, contrast medium was instilled into the cyst to ensure that there was no communication with the pelvicalyceal collecting system, to exclude any leakage from the puncture site into the retroperitoneal cavity and to determine the presence of extravasation (Fig. 1C). The patients were then randomized into the ethanol and hypertonic saline groups; 95% ethanol or 20% hypertonic saline, respectively, which corresponded to 75% of the aspiration volume, was injected through the catheter into the cyst and this was left in place for 20 minutes. However, for a large cyst greater than 400 ml, the amount of sclerosants was limited to 100 ml to avoid systemic side effects. Before removal of the ethanol or hypertonic saline, the patients were placed in the prone, supine, and lateral decubitus positions for a minimum of 5 minutes each to allow adequate contact of the ethanol with all areas of the cyst wall (25). The ethanol or hypertonic saline was then removed and the pigtail catheter was removed (Fig. 1D). Sclerotherapy was deemed as technically successful if the procedure went uneventfully without any complication.


Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst.

Egilmez H, Gok V, Oztoprak I, Atalar M, Cetin A, Arslan M, Gultekin Y, Solak O - Korean J Radiol (2007 Nov-Dec)

Representative CT images of a 53-year-old male patient with a simple renal cyst.A. The simple renal cyst before aspiration.B. A 5.4-Fr pigtail catheter was inserted into the cyst.C. Contrast medium is instilled into the cyst to ensure that there was no communication with the pelvicalyceal collecting system, to exclude any leakage from the puncture site into the retroperitoneal cavity and to determine the presence of extravasation.D. The cyst disappeared after successful ethanol sclerotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627454&req=5

Figure 1: Representative CT images of a 53-year-old male patient with a simple renal cyst.A. The simple renal cyst before aspiration.B. A 5.4-Fr pigtail catheter was inserted into the cyst.C. Contrast medium is instilled into the cyst to ensure that there was no communication with the pelvicalyceal collecting system, to exclude any leakage from the puncture site into the retroperitoneal cavity and to determine the presence of extravasation.D. The cyst disappeared after successful ethanol sclerotherapy.
Mentions: The sclerotherapy was performed under CT guidance on an outpatient basis. The patients were placed in the prone position and local anesthesia was achieved with 2% lidocaine hydrochloride that was applied to the puncture site. The patient was given nothing by mouth for 4-8 hours prior to the procedure. Prophylactic antibiotics were administered 60 minutes prior to the procedure and they were continued for at least 24 hours after the procedure. For all the patients, their coagulopathies were corrected prior to the procedure to decrease the chance of developing a perirenal hematoma or renal hemorrhage. Patients with bleeding tendencies, including those who were taking anticoagulants, did not undergo sclerotherapy until their clotting parameters were brought within normal limits, when possible. A pigtail catheter 5.4-Fr (PBN Medicals, Denmark) was inserted with using a trocar-catheter system under CT guidance (Figs. 1A, B). The cyst fluid was aspirated as completely as possible and it was sent to the laboratory for cytologic and biochemical examination. The total amount of the aspirated fluid was measured to record the cyst's volume. The cyst was then filled with a half-and-half mixture of water-soluble contrast medium (Telebrix 35 [350 mg iodine/ml], Guerbet Laboratories, Aulnaysous-Bois, France) with normal saline. For patients who were undergoing sclerotherapy, contrast medium was instilled into the cyst to ensure that there was no communication with the pelvicalyceal collecting system, to exclude any leakage from the puncture site into the retroperitoneal cavity and to determine the presence of extravasation (Fig. 1C). The patients were then randomized into the ethanol and hypertonic saline groups; 95% ethanol or 20% hypertonic saline, respectively, which corresponded to 75% of the aspiration volume, was injected through the catheter into the cyst and this was left in place for 20 minutes. However, for a large cyst greater than 400 ml, the amount of sclerosants was limited to 100 ml to avoid systemic side effects. Before removal of the ethanol or hypertonic saline, the patients were placed in the prone, supine, and lateral decubitus positions for a minimum of 5 minutes each to allow adequate contact of the ethanol with all areas of the cyst wall (25). The ethanol or hypertonic saline was then removed and the pigtail catheter was removed (Fig. 1D). Sclerotherapy was deemed as technically successful if the procedure went uneventfully without any complication.

Bottom Line: Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography.The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group.The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey. hegilmez@cumhuriyet.edu.tr

ABSTRACT

Objective: We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts.

Materials and methods: A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography.

Results: The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group.

Conclusion: Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.

Show MeSH
Related in: MedlinePlus