Brown Dominic, Nalagatla Sarika, Stonier Thomas, Tsampoukas Georgios, Al-Ansari Abdulla, Amer Tarik, Aboumarzouk Omar M
Department of Urology, Broomfield Hospital, Chelmsford, UK.
Department of Urology, University Hospital Monklands, Glasgow, UK.
Abdom Radiol (NY). 2021 Jun;46(6):2875-2890. doi: 10.1007/s00261-021-02953-9. Epub 2021 Feb 5.
Simple renal cysts are common benign lesions of the kidney with up to 4% of patients developing symptoms necessitating intervention including pain and haematuria. We conducted a systematic review of the literature to determine the efficacy and safety of aspiration-sclerotherapy of symptomatic simple renal cysts. A systematic review using Cochrane guidelines was conducted on published literature from 1990 to 2020. RCTs, cohort studies and case series meeting the inclusion criteria were reviewed and cumulative analysis of outcomes was performed. A total of 4071 patients from 57 studies underwent aspiration ± sclerotherapy for their simple renal cysts. 87.7% of patients who had aspiration with sclerotherapy demonstrated 'treatment success' with a >50% reduction in cyst size and complete resolution of symptoms. 453 minor, transient complications occurred (11.2%) whilst a major complication rate of less than 0.1% (4 patients) was reported. Pooled analysis of all available current literature demonstrates that aspiration-sclerotherapy is a safe and effective first-line therapy for symptomatic simple renal cysts. Although we are unable to compare those undergoing aspiration alone to aspiration-sclerotherapy, it is evident the use of a sclerosing agent is integral to treatment success; however, the optimum agent, volume, injection frequency, and dwelling time are yet to be defined. Cyst size should be considered when discussing treatment options; however, we conclude it reasonable for aspiration-sclerotherapy to be used in the first instance in all cases of symptomatic simple renal cysts. Furthermore, we propose definitions of treatment outcome measures in order to allow direct comparative analysis across future studies.
单纯性肾囊肿是常见的肾脏良性病变，高达4%的患者会出现需要干预的症状，包括疼痛和血尿。我们对文献进行了系统回顾，以确定症状性单纯性肾囊肿穿刺硬化治疗的有效性和安全性。按照Cochrane指南对1990年至2020年发表的文献进行了系统回顾。对符合纳入标准的随机对照试验、队列研究和病例系列进行了综述，并对结果进行了累积分析。共有来自57项研究的4071例患者接受了单纯性肾囊肿的穿刺±硬化治疗。接受穿刺硬化治疗的患者中有87.7%显示“治疗成功”，囊肿大小缩小>50%且症状完全缓解。发生了453例轻微、短暂的并发症（11.2%），而据报道严重并发症发生率低于0.1%（4例患者）。对所有现有文献的汇总分析表明，穿刺硬化治疗是症状性单纯性肾囊肿安全有效的一线治疗方法。虽然我们无法将单纯接受穿刺的患者与穿刺硬化治疗的患者进行比较，但显然硬化剂的使用是治疗成功的关键；然而，最佳的药物、剂量、注射频率和留置时间尚未确定。在讨论治疗方案时应考虑囊肿大小；然而，我们得出结论，对于所有症状性单纯性肾囊肿病例，首先使用穿刺硬化治疗是合理的。此外，我们提出了治疗结果指标的定义，以便能够对未来的研究进行直接的对比分析。
