Pelvis beside cyst

Pelvis beside cyst is a benign cyst originated in the renal parenchyma at the renal hilum , and not connected with the collection system . Cause of lymphatic dilation may be caused by chronic inflammation . The main renal cysts and oppression caused by the collection system or renal pedicle artery and complications related to the performance of low back pain , high blood pressure , urine and other symptoms of urinary tract infection , whether symptomatic cyst location, size and its complications are very correlation. Initial diagnosis of the disease depends imaging , CT diagnosis of this disease is the most affirmative role , IVP examination in the diagnosis of the disease also has a high accuracy rate , can understand the bilateral renal function , renal collecting system morphology and complications of renal hilum and easy tips lesions , should be used as a routine examination . B- considered in the diagnosis of this disease is sometimes misdiagnosed as hydronephrosis, the B -scan and unexplained kidney disease should exist in the water may need further examination. CT scan showed cysts in the renal hilum , with normal renal parenchyma apart, the lowest density halo around the renal sinus fat in the cyst is composed parapelvic cysts characteristic performance , CT scan pelvis beside the cyst with hydronephrosis similar, but enhanced scan without enhancement, development of the renal pelvis , calyces pressure and stretched, the cyst can be set off more clearly. Based on medical history and laboratory examinations beside these cysts diagnosed patients with renal pelvis . Differential diagnosis of cystic renal pelvis side as follows: 1 , hydronephrosis : hydronephrosis by the urinary system , the innate and acquired multiple factors , can occur at all ages . Patients have no obvious clinical symptoms, there may be a sense of expansion and abdominal mass waist severe hydrocephalus . Calculi in patients with intermittent hydronephrosis can cause renal colic , accompanied by nausea , vomiting , abdominal distension and oliguria and so on. Examination palpable increase in severe hydronephrosis , such as infection can occur pyuria and systemic symptoms of infection . The diagnosis relies on ultrasound , IVP, CT and MRI and so on. 2 , kidney cancer: is more common cancer of the urinary system , divided into two types of benign and malignant , benign rare. No typical clinical symptoms of benign tumor , larger waist and abdominal pain can occur when the discomfort , physical examination palpable enlarged kidneys. Typical clinical manifestations of kidney cancer is hematuria , flank pain and swelling . The diagnosis relies on ultrasound, CT and MRI and other enhancements , more performance for solid lesions , showed a cystic individual characteristics . Pelvis due next cysts are benign lesions, cysts are small and asymptomatic, can be regular follow-up , when the cyst diameter > 5cm, or compression symptoms and complications , should take active surgery. Surgical methods are open cyst decortication , B ultrasound-guided aspiration of cyst fluid injection sclerotherapy and laparoscopic cystectomy and so on. Gate structure is complex due to renal cysts deep aspiration of cyst fluid injection sclerotherapy can easily lead to complications and recurrence rate and therefore should not be used . Traditional open surgery requires a large incision line waist , large body injury , postoperative recovery was slow , long hospital stay . Laparoscopic due to multiple angles and have amplification, fully exposed to surgery , bleeding effect, minimally invasive, worthy of promotion. ( PLA General Hospital Urology Guo Gang ) Third, expert comments from histologically parapelvic cyst into the urine -derived and non- urinary -derived two, the latter can be divided into serous and lymphatic . Parapelvic cyst is caused by congenital factors , but most patients after the age of 50 to appear next to the pelvis cysts , and the past often urinary tract infection, obstruction or a history of stone , may be chronic inflammation of the lymphatic vessels of the pelvis , obstruction, leading to local lymphangiectasis , localized renal sinus vascular disease or vascular disuse atrophy , also can cause renal sinus serous exudate to the plane , where the formation of limited serous cysts. Urine cyst cyst may be formed to extend the renal hilum renal parenchyma . The disease is more common in patients over the age of 50 , a similar proportion of men and women next to asymptomatic patients with cystic renal pelvis , clinical symptoms are more common in men . Clinical manifestations may include lower back pain and discomfort , hematuria , hypertension or with intracapsular stones, some patients are asymptomatic, discovered by chance during examination . According to B- , IVU and CT examination can confirm the diagnosis. There is a liquid dark area near the B- visible renal hilum , and can display the size of the cyst , but extends to the renal sinus cyst causing hydrocephalus renal pelvis , or renal sinus cysts located deep when misdiagnosed as hydronephrosis . IVU examination can be found in the kidney or renal sinus door with a circular mass oppression of the renal pelvis , ureter or renal calyx , there arc pressure trace , deformation, displacement or stretched, such as cysts and renal pelvis is no traffic , then swollen no matter contrast agents, small cysts can be no such changes . CT examination is the most reliable method of diagnosis , clear boundaries can be displayed beside the pelvis oval uniform mass density , CT value of 0 ~ 2 0HU, after little change in the value of enhanced CT , can be diagnosed as benign cysts pelvis next ; parapelvic cysts in the renal sinus , large cysts may apply to the renal hilum prominent ; whereas renal cysts were located in the renal cortex , round, can be single or multiple. B -ultrasound and CT examination can help in the differential diagnosis . In addition , CT examination of the identification of cystic renal cell carcinoma is also important diagnostic value. Small asymptomatic cysts may periodically B ultrasonic examination , close follow-up . For large cysts , local compression renal pelvis clinical symptoms or suffering from kidney stones and intracapsular merger combined with other diseases such as hamartomas are advised surgery. The traditional surgical approach is to remove most of the wall , with anhydrous alcohol destroy residual epithelial cysts and renal pelvis filling fat around the pedicle . Surgery should be noted whether the cysts pelvis , calyces have traffic , especially in patients with intracapsular merger stones. There are reports using B ultrasound-guided needle aspiration of cyst fluid way to cure cystic renal pelvis side , this simple method beside pelvis cysts , may be a better treatment , but parapelvic cysts and renal vascular pedicle adjacent to operate should have more skilled renal cyst puncture technique to prevent serious complications . Laparoscopic surgery parapelvic cyst on the surgeon's technical requirements, we should note the following: (1) before surgery clearly cyst location, size , number and relationship with peripheral vascular , renal collecting system ; ( 2 ) due to the pelvis next to the cyst near the renal hilum , separated parapelvic cyst should be careful ; laparoscopic renal vein and inferior vena cava wall of dark blue , similar to the top of the cyst , attention should be identified , careful operation , avoid damage renal pedicle vessels ; ( 3 ) If the cyst and the expansion of the renal pelvis can be difficult to distinguish when squeezed pelvis , pelvis becomes empty, the cyst did not change , it could be given before surgery followed by cystoscopy retrograde ureteral catheter inserted for guidance , intraoperative injection of methylene blue , identify cysts and renal pelvis, and whether pelvis incision ; further guidance on laparoscopic puncture pale yellow liquid verifiable cyst ; ( 4 ) should be resected from the substance of the wall 3 ~ 4mm, so as not to cause renal bleeding is difficult to control ; ( 5 ) anatomy encountered poor visibility , variability , bleeding should be promptly converted to open surgery ; ( 6 ) the renal pelvis in the door next to fat filled cysts may further prevent recurrence ; ( 7 ) urologists familiar with the anatomy of the abdominal cavity , single next to the side of the pelvis can be retroperitoneal cyst way , bilateral cysts can be processed simultaneously by the intraperitoneal route , give full play to its advantages of minimally invasive . Laparoscopic treatment of parapelvic cyst safe, reliable, fully embodies the advantages of minimally invasive laparoscopic surgery. With the growing popularity of laparoscopic techniques and the development of laparoscopic cyst cyst will become the preferred method of treatment parapelvic .