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Anatomy
Indications
- Flank pain
- Hematuria
- Hypertension
- Compression of the pelvicalyceal system
Contra Indications
- Infectious renal cysts
- Autosomal dominant polycystic kidney disease (ADPKD)
- Cystic tumor of the kidney
- Coagulopathy
- Uncertainty about the relationship between the cyst and clinical symptoms
Workup
- Cliniacl assesment
- Ultrasound (US) examination
- Computerized Tomography
- Correction of anticoagulation if necessary
Material
Essentials
- Ultrasound
- Chlorhexidine
- Standard angiography set
- Lidocaine 1% 10 ml
- Contrast medium
- Heparine 5.000 IU/ml
- Heparinized saline (5.000 IU/l)
- 6F Introducer
- 0.035" Amplatz Stiff guidewire
- 8F multisidehole pigtail catheter
- Sclerosing Agent: 96% alcohol
Non Essentials
Positioning
Prone/oblique
Steps
- Time-out
- Sterile washing and draping
- Local anaestectic under ultrasound guidance
- Ultrasound guided puncture of the cyst
- Over the wire introduction of the pig-tail catheter
- Aspiration of the cyst content
- Installation of diluted contrast medium to exclude a connection with the collecting system (50% of the aspirated volume)
- Aspiration of the diluted contrast medium
- Installation of 98% alcohol (30% of the aspirated volume) with a max of 250 ml
- Alcohol remained in the cyst cavity for 2 hours
- Patient should rotate (at least semi-rotate) every 10 minutes
- Alcohol is then evacuated
- Catheter was removed
- Sign-out
Tips & Tricks
- In case of severe pain remove the alcohol and terminate the procedure
- Alcohol concentration in blood is not tested routinely.
- For giant cysts with recurrence and loin pain after initial treatment, additional prolonged catheter drainage is used successfully
| Pain | most common | |
| Fever | common | |
| Hematuria | common | |
| Nausea | common | |
| Intracystic Hemorrhage/Cyst Rupture | uncommon | |
| Ethanol Toxicity/Intoxication | uncommon | |
| Kidney/Pelvic Damage | uncommon | |
| Infection | uncommon | |
- Patients rested in bed for 2 hours after the procedure
- Vital signs every 15 minutes for 2 hours
Follow up
3 months
* Clinical assessment
* Ultrasonography
* CT scan
Folder
Literature
Report
Time-out
Steriel wassen en afdekken. Lokale anesthesie met 1% Lidocaine. Echogeleide punctie van de cyste. Introductie van de pigtailkatheter over de voerdraad. Aspiratie van de cyste-inhoud. Installatie van verdund contrastmiddel (50% van het geaspireerde volume), een connectie met het verzamelsysteem wordt niet aangetoond. Aspiratie van het verdunde contrastmiddel. Installatie van 98% alcohol (30% van het geaspireerde volume) met een maximum van 250 ml. De alcohol bleef 2 uur in de cysteholte. Patiënt elke 10 minuten gedraaid (minimaal semi-rotatie). De alcohol wordt vervolgens geëvacueerd. De katheter werd verwijderd.
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Time-out
Sterile washing and draping. Local anesthesia with 1% Lidocaine. Ultrasound-guided puncture of the cyst. Introduction of the pigtail catheter over the guidewire. Aspiration of the cyst contents. Installation of diluted contrast medium (50% of the aspirated volume), no connection with the collecting system is demonstrated. Aspiration of the diluted contrast medium. Installation of 98% alcohol (30% of the aspirated volume) with a maximum of 250 ml. The alcohol remained in the cyst cavity for 2 hours. Patient rotated every 10 minutes (at least semi-rotation). The alcohol is then evacuated. The catheter was removed.
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