Surgical Management of Complex Renal Cysts

A Series of 32 Cases

Cloix, Pierre
Martin, Xavier
Pangaud, Catherine
Marechal, Jean-Marie
Bouvier, Raymonde
Barat, Didier
Dubernard, Jean-Michel

From the Departments of Urology and Renal Transplantation, Radiology and Pathology, Hopital Edouard Herriot, Lyon, France.
Accepted for publication January 26, 1996.
(X. Martin) Requests for reprints: Department of Urology and Renal Transplantation, Hopital Edouard Herriot, Place d'Arsonval, 69437 Lyon, Cedex, France.

Journal of Urology 156(1):p 28-30, July 1996.

Purpose

The differentiation between benign cysts of the kidney and those that require surgical exploration remains difficult. The accuracy of radiological techniques (ultrasound, computerized tomography [CT], angiography, magnetic resonance imaging, cyst puncture and intraoperative pathological examination) is analyzed.

Materials and Methods

Surgical exploration was performed in 30 patients with 32 asymptomatic renal cysts, and the pathological specimens were compared retrospectively to the radiological findings. The classification of Bosniak was used to categorize the ultrasound and CT findings.

Results

Of our complex renal cysts 41 percent proved to be malignant. Our results suggest that the radiological techniques are not well suited for characterization of these cysts. None of the Bosniak types was sufficiently predictive of the lesion. Only a Bosniak score of 4 (the sum of ultrasound and CT Bosniak types) was not associated with renal cell carcinoma. According to the radiological findings, 1 patient was under treated (recurrent renal cell carcinoma) and 4 were over treated (radical nephrectomy for benign lesions).

Conclusions

A practical therapeutic strategy is described in which radical nephrectomy is performed when malignant lesions are detected either by preoperative or intraoperative techniques. Conservative surgery is indicated for benign cysts according to the clinical status and risks of nephron sparing surgery.