The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts

Abstract

Objective: To compare the efficacy and safety of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts.

Materials and methods: Between 2008 and 2013, symptomatic Bosniak type I renal cysts with a diameter larger than 5 cm in ultrasonography (US) or computed tomography were included in the study and divided into two groups. Group 1 patients were treated by US-guided percutaneous polidocanol sclerotherapy, and group 2 patients were treated by US-guided percutaneous ethanol sclerotherapy. The pre-operative and postoperative US findings were documented to compare the cyst recurrence and the reduction in cyst size. Success was defined as complete or partial: as >90% reduction or 50-90% reduction in cyst size, respectively. Failure was defined as <50% reduction in cyst size. The success rates of two groups were compared. Intraoperative pain was assessed using a visual analog scale (VAS) just after the operation.

Results: The median follow-up period was 36 months (range 12-76) in group 1 and 39 months (range 10-78) in group 2. Group 1 consists of 86 patients with 89 simple renal cysts, and group 2 consists of 57 patients with 57 simple renal cysts. Anatomical success was documented in 49 (55.1%) and 48 (84.2%) cysts in groups 1 and 2, respectively (p < 0.001). Clinical success was seen in 56 (65.1%) and 43 (75.4%) patients in groups 1 and 2, respectively. Major complication was detected in only one patient in group 2 (aseptic psoas abscess), and there was not any major complication in group 1. Minor complications had occurred in ten patients in group 2 (microscopic hematuria in six patients and fever and nausea in four patients) and in eight patients in group 1 (microscopic hematuria in six patients and fever and nausea in two patients). The mean VAS scores were 21 ± 1.04 and 4.26 ± 1.99 in ethanol and polidocanol groups, respectively (p < 0.001). Ethanol was found to be significantly painful, compared to polidocanol in the sclerotherapy of simple renal cysts.

Conclusions: Although the complication rates and VAS scores of ethanol sclerotherapy are higher than those of polidocanol sclerotherapy, its success rates appear to be also higher. The decision of which sclerosing agent will be used should be based on patients' comorbidities, cyst location and the surgeon's experience.