Diagnosis and surgical treatment of renal hydatid disease: a retrospective analysis of 30 cases

Abstract

Echinococcosis (CE) is an infection which is caused by the larval stage of a tapeworm and is endemic in stockbreeding regions of developing countries. The kidney is the most commonly affected organ in the urinary tract. However, reports on renal hydatid disease are limited in the literature, and usually there are no specific clinical characteristics and promising operative methods. The purpose of this study is to assess the most appropriate surgical technique for the patient with urinary tract CE. We retrospectively analyzed thirty patients with renal hydatid cysts who received different surgical treatments in the urology department of the First Affiliated Hospital of Xinjiang Medical University from February 1985 to April 2010. Twenty patients were males and ten were females. The diagnostic accuracy was 74%, 87.5%, and 66.6% respectively by using of ultrasound, CT, and laboratory tests. Thirty patients were followed up for 1-15 years after surgery. One patient experienced a recurrence of renal CE. The ultrasound, CT, and immunological tests are an important means of diagnosis. The surgical treatment principle of renal hydatid should be based on residual renal function, hydatid cyst size, number, location, and surgical techniques to determine the surgical plan to retain the renal function.

Figure 1. Type CE2 disease in a 28-year-old Uighur female patient.

The patients has been found with an asymptomatic cystic mass in her left kidney by ultrasonography incidentally and diagnosed as renal hydatid cyst by further CT scanning one year before her admission to the hospital. She had a history of exposure to sheep and goats. And no family history of hydatid disease was identified. Physical examination observed a palpable mass in the left lumber region. Ultrasound revealed a univesicular cyst of 104×78×83 mm on the upper pole of the left kidney; CT confirmed the presence of hydatid cysts in the kidney.

Figure 2. Intraoperative view of total external capsule excision.

View of the hydatid cyst located in the in the left kidney (A); carefully dividing the intact ectocyst through the intra-adventitial space (B); Total cystectomy was performed A wound after complete removal of hydatid (A–B). Communicated with perirenal space during the procedure, and was closed by absorbable sutures and a F14 nephrostomy tube was placed in the calyx. A drainage was placed on perirenal space confirming no significant hemorrhage on surgical field, the wound was closed(C–D). Gross appearance and histopathologic examination of the cystic mass confirmed the hydatid disease, pathological analysis of the resected specimen was positive for scolices of Echinococcus granulosus (E–F).