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Treatment of large kidney cysts without surgery

The absolute alcohol injection method is used to permanently destroy large kidney cysts causing low back pain without surgery.

Visiting Tam Anh General Hospital in Hanoi with pain in the right lower back for months, Ms. Ho Thi Binh (66 years old, Hanoi) was diagnosed with a cyst with a diameter of 73 x 98 mm located at the upper pole of the right kidney. The cyst presses on a neighboring organ, causing constant pain in the side.

According to BS.CKII Le Van Khanh, Center for Diagnostic Imaging and Interventional Radiology, Hanoi Tam Anh General Hospital, usually a large kidney cyst with symptoms like Mrs. Binh will be surgically removed. However, this method is painful and has many potential complications after surgery such as infection, bleeding, especially when the patient is old and has many underlying diseases. “We decided to use absolute alcohol aspiration and injection methods to completely destroy the cyst while preserving the kidney and surrounding organs as much as possible, helping the patient avoid surgery,” said Dr. Khanh.

Ultrasound image of Mrs.  Binh showed that the right kidney cyst was 73x98mm in size.  Photo: Tam Anh General Hospital

Ultrasound image of Mrs. Binh showed a right kidney cyst measuring 73×98 mm. Photo: Tam Anh General Hospital

Ms. Binh was given a local anesthetic, then the doctor used a 2-3mm diameter drainage tube to penetrate the cyst wall into the cyst to aspirate the fluid under ultrasound guidance and computed tomography. The drainage line is cleverly inserted to avoid the whole abdominal organs such as intestine, stomach, liver, spleen with the shortest length.

After 30 minutes, all 300 ml of cyst fluid was aspirated, sent for microbiological and pathological examination to rule out infection or malignancy. The doctor injects 96% absolute alcohol into the cyst, waits about 30 minutes for the alcohol to work to permanently kill the cyst, then withdraws the alcohol. Binh said that she could feel the symptoms of severe back pain subside quickly when the doctor carried out the procedure. She was discharged the same day and was able to walk and do normal activities the following day.

Safe treatment of kidney cysts, keep the kidneys as much as possible

Kidney cyst is an abnormal mass that forms on one or both sides of the kidney, the surface is smooth round, filled with fluid inside. According to Assoc. Prof. TS.BS Nguyen Xuan Hien, Director of the Center for Diagnostic Imaging and Interventional Radiology, Tam Anh General Hospital, Hanoi, Renal cysts are the most common benign lesion of the kidney with incidence increasing with age. especially in the elderly and those with underlying medical conditions.

The doctor aspirated more than 300ml of renal cyst fluid from the patient.  Photo: Tam Anh General Hospital

The doctor aspirated more than 300ml of renal cyst fluid from the patient. Photo: Tam Anh General Hospital

The cause of kidney cysts is unknown, but some theories suggest that it may be due to urinary retention in the kidney unit or genetics.

Usually, kidney cysts develop silently and cause certain clinical symptoms. The patient is only discovered by chance through a physical examination or some other disease. In some cases, when the cyst grows in size, it can cause symptoms such as: severe pain in addition to the kidney cyst, blood in the urine or pale pink urine, pain when urinating. . The patient may also have fever, chills due to infection or bleeding in the kidney cyst. At this time, it is very important to intervene in treatment to avoid dangerous sequelae in the future.

In some cases, hypertension is caused by a cyst pressing on a renal artery, stimulating regulatory mechanisms to increase blood pressure. Doctors can detect enlarged kidneys on a physical exam.

TS.BS Associate Professor Nguyen Xuan Hien (center) is intervening.  Photo: Tam Anh General Hospital

TS.BS Associate Professor Nguyen Xuan Hien (center) is intervening. Photo: Tam Anh General Hospital

Associate Professor Nguyen Xuan Hien said that asymptomatic kidney cysts do not require treatment, they only need to be monitored every 6 months via ultrasound. When the cyst is large and shows unpleasant symptoms, affecting daily life and work, the patient should go to the hospital for treatment, avoid leaving it for too long, causing the cyst to press on the kidney tissue, affecting kidney function.

For kidney cysts, there are currently 3 main treatment methods: open surgery, laparoscopic surgery and absolute alcohol injection. Although open surgery to remove the cyst is effective and reduces recurrence rates, it is painful for the patient, requires a long hospital stay, and leaves a large scar. Laparoscopic surgery is not very painful but still requires anesthesia, the patient still has to undergo surgery with some risk of complications.

Assoc Hien evaluated the cyst draining method and absolute alcohol injection as safe and effective options in the treatment of renal cysts. According to recommendations from the American Endocrine Society, this method is less likely to cause complications, with a complete cyst eradication efficiency of over 80% with just one needle puncture. In Vietnam, this technique was first applied in 1995, since then it has shown high efficiency in the treatment of renal cysts.

“Aspiration kidney cysts and alcohol injection are very suitable for the case of elderly patients who are not healthy enough to carry out surgery, the cost is also lower than surgery. Not only kidney cysts but other types of cysts. on the body such as thyroid cysts, mammary gland cysts… all can be treated with this method,” said Associate Professor Nguyen Xuan Hien.

Ha Thanh

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