Selective ablation of symptomatic dominant renal cysts using 99% ethanol in adult polycystic kidney disease

ObjectivesTo evaluate the clinical efficacy and outcome of 99% ethanol as a sclerosing agent for managing chronic flank pain due to dominant cysts in selected patients with adult polycystic kidney disease. Traditionally, such patients have been treated with analgesics and surgical/laparoscopic deroofing. Cyst aspiration sclerotherapy is a minimally invasive therapeutic option for such patients, and limited published data exist on this subject. This formed the basis for the present study.MethodsA pilot study was undertaken during a 1-year period to evaluate the clinical efficacy of ultrasound-guided cyst aspiration-ethanol injection sclerotherapy in 15 preselected patients with diagnosed adult polycystic kidney disease. All punctures were performed with strict aseptic precautions and local anesthesia on an outpatient basis. The patients were evaluated with serial scans, pain scores, and serum creatinine values.ResultsA total of 48 dominant cysts were successfully treated in all 15 patients with regard to cyst aspiration and shrinkage. At the end of 1 year, the pain and dominant cysts had completely disappeared in 13 patients and had recurred in 2; repeat cyst aspiration and sclerotherapy was done in 3 patients. Nephrocutaneous fistula and urinary tract infection occurred in 1 patient each. The decrease in the pain score and the rise in the serum creatinine level were statistically significant at P <0.05 and P <0.001, respectively.ConclusionsAlcohol cyst sclerotherapy is a minimally invasive, safe, and effective alternative to conventional surgical/laparoscopic deroofing for managing chronic flank pain due to adult polycystic kidney disease in selected patients. It should be considered as a safe and viable therapeutic option in patients in whom the primary symptom is chronic flank pain due to one or more dominant cysts.