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CASE REPORT
Year : 2001  |  Volume : 17  |  Issue : 2  |  Page : 167-169
 

A feasible approach to renal hydatid cyst: Presentation of two cases and review of literature


Department of Urology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
N P Gupta
Department of Urology, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Renal; Hydatid Cyst; Partial Nephrectomy.


How to cite this article:
Gupta N P, Ansari M S, Singh I. A feasible approach to renal hydatid cyst: Presentation of two cases and review of literature. Indian J Urol 2001;17:167-9

How to cite this URL:
Gupta N P, Ansari M S, Singh I. A feasible approach to renal hydatid cyst: Presentation of two cases and review of literature. Indian J Urol [serial online] 2001 [cited 2019 Sep 15];17:167-9. Available from: http://www.indianjurol.com/text.asp?2001/17/2/167/20264



   Introduction Top


Hydatid disease (HD) is caused by the cestode Echino­coccus granulosus mainly involving the liver and the lung. Kidney involvement is rare in hydatid disease and consti­tutes only 2-4% of all cases. Echinococcosis or hydatid disease (HD) is a parasitic infestation endemic in coun­tries such as Australia, New Zealand, South America, east­ern Africa, southern Europe, Middle East and Turkey. [1] From India there have been anecdotal case reports of re­nal hydatid disease. [2],[3],[4] We report two cases of renal hy­datid disease (RHD), one managed by partial nephrectomy (PN) and the other by nephrectomy and, review of litera­ture to evaluate the place of nephron-sparing surgery (NSS) in the management.


   Materials and Method Top


2 patients (30 and 35-year-old), both males with RHD were treated. The first case presented with dull aching pain along with a sense of heaviness in right flank for a period of 6 months. Physical examination did not show any lump except tender­ness on deep palpation in the right flank. The second case pre­sented with dull aching continuous pain and a gradually increasing lump in right lumbar region of one year's duration. He also passed membranes in the urine (Hydatiduria). Physi­cal examination showed a tender right renal lump. The results of both the cases of laboratory and radiological investigations [Figure - 1],[Figure - 2],[Figure - 3] are shown in [Table - 1].


   Discussion Top


Man represents an intermediate host for the tapeworm of genus Echinococcus. Although 3 species are known to af­fect man, hydatid cysts are most frequently caused by E. granulosus. Genitourinary involvement is almost always renal but prostatic, bladder and epididymal involvements have also been reported. [5] So far in the literature, nearly 475 cases of genitourinary hydatid disease have been reported, out of which 450 cases are of renal origin [Table - 2].

Clinical features are not diagnostic of hydatid disease. Eosinophilia is found only in 30% of the patients. Sero­logical tests have given equivocal results and show a high incidence of false negative rate due to circulatory immune complexes and cross reactivity with other parasitic infec­tions. [6] Among the radiological investigations CT scan is more sensitive and accurate than ultrasonography. Accu­racy of CT has been reported to be more than 90%. [7] Intra­venous urography might show distortion and displacement of pelvicalyceal system or an intrapelvic filling defect and opacification of hydatid cyst with contrast media if the cyst is communicating with pelvicalyceal system. However a retrograde pyelogram may be more informative in these cases.

The only treatment of hydatid disease is surgery. The various modalities used in the literature are percutaneous drainage and instillation of scolicidal, enucleation, cystec­tomy, de-roofing, nephrectomy and partial nephrectomy. [6],[8] Although there is no effective medical therapy for hydatid disease, pretreatment with albendazole alone or in combi­nation with praziquentel is very important as the cyst mate­rial becomes non-antigenic, cyst tension is reduced and thus reducing the risk of spillage. [9] Post-operatively albendazole has shown to reduce the risk of implantation of scolices. [10] The recommended dose of albendazole is 400 mg 2 times a day for 28 days, repeated 1 to 8 times separated by an intervat of 2-3 weeks. It is preferable to give albendazole for more than 28 days when there are thick-walled cysts.

Usually the diagnosis of hydatid disease of the kidney is made late, when the cyst is large and total nephrectomy is the only possible surgical treatment. Although some authors have recommended cyst puncture as diagnostic and therapeutic modality, it carries the risk of acute ana­phylaxis, laryngeal oedema, respiratory arrest and dissemi­nation of daughter cyst. [5] Renal preserving modalities like percutaneous drainage and instillation of scolicidal, enu­cleation, cystectomy, pericystectomy or de-roofing have been reported to produce significant complication, mor­bidity and a recurrence rate to the tune of 30%. [3] Whereas partial nephrectectomy (PN) proved to be quiet safe and effective without the risk of any secondary echinococco­sis along with the preservation of the organ. Halim et al reported 13 cases of RHC, out of which 6 were treated with nephrectomy, 6 with excision of the cyst and 1 with partial nephrectomy. All including partial nephrectomy did well except that patients undergoing excision of the cyst showed postoperative haematuria. [11] Benchekroun et al re­ported 45 patients, out of which de-roofing was done in 18, pericystectomy in 6, total nephrectomy in 18 and par­tial nephrectomy (PN) in 2. No complication was reported in both partial as well as total nephrectomy group but 2 cases of urinary fistula were reported in the patients un­dergoing de-roofing. [13] Other workers like Afsar et al per­formed partial nephrectomy (PN) in 3 patients, Baykal et al in 3 patients and Odev et al in 4 patients of RHD with­out any significant morbidity and complications. [14],[15],[16] The comparison of certain series with the different types of treatment and the results is given in [Table - 2]. It is evident that the results of PN are excellent without any complica­tion, morbidity and recurrence of the disease.

In the present study, we treated 1 case by partial nephrec­tomy (PN) and recommend the same whenever it is feasible. Surgical approach was made via an extraperitoneal incision through the bed of 12 th rib. Pedicle was dissected and hilar control was taken and lower-pole partial nephrectomy was done similar to the technique described by Novick. [17] At a follow-up of 1 year serological test was negative and ultrasound abdo­men did not show any new lesion. In the second patient ne­phrectomy was done as the lesion involved two-thirds of the kidney and the cyst was communicating with the pelvicalyceal system. Surgical treatment of hydatid disease requires particu­lar care since the cyst contents are infectious and cause ana­phylactic shock. Exposure should be extraperitoneal and spillage of cyst content avoided. If the cyst is tense and there is eminent danger of cyst puncture during surgery, it should be injected with scolicidal solutions such as 30% normal saline, 1 % iodine, 10% formuline, or 0. 5% hydrogen peroxide.

In conclusion, partial nephrectomy (PN) is safe and ef­fective for the management of RHD without the loss of organ. Follow-up investigations include serological tests, intravenous urography and ultrasonography. Postoperative follow-up for at least 5 years is recommended.

 
   References Top

1.Shetty SD, AL-Saigh A. Ibrahim AIA, Patil KP, Bhattachan CL. Management of hydatid cysts of the urinary tract. Br J Urol 1992; 70: 258-261.  Back to cited text no. 1    
2.Baijal SS, Basarge N. Srinadh ES, Mittal BR. Kumar A. Percutane­ous management of renal hydatidosis: a minimally invasive thera­peutic option. J Urol 1995; 153: 1199-1201.  Back to cited text no. 2    
3.Goel MC, Agarwal MR. Misra A. Percutaneous drainage of renal hy­datid cyst: early results and follow-up. Br J Urol 1995; 75: 724-728.  Back to cited text no. 3    
4.Mukherji AK, Mukherji S, Sen JK. Renal hydatid cyst presenting with hypertension. J Assoc Physicians India 1976: 24: 49-51.  Back to cited text no. 4    
5.Buckley RJ, Smith S, Hershorn S. Echinococcal disease of the kid­ney presenting a renal filling defect. J Urol 1985: 133: 1660-1661.  Back to cited text no. 5    
6.Craig PS, Zeyhle E. Romig T. Hydatid disease: Research and con­trol in Turkana II - The role of immulogical techniques for the diagnosis of hydatid disease. Trans R Soc Trop Med Hyg 1986; 80: 183-192.  Back to cited text no. 6    
7.Roylance J. Davies ER, Alexender WD. Traumatic puncture of re­nal hydatid cyst. Br J Radiol 1973; 46: 960-963.  Back to cited text no. 7    
8.Shetty SD, AL-Saigh A. Ibrahim AIA, Malatani T. Patil KP. Hy­datid disease of the urinary tract: evaluation of diagnostic methods. BJU 1992; 69: 476-480.  Back to cited text no. 8    
9.Hortan RJ. Chemotherapy of echinococcal infection in man with albendazole. Aust NZJ Surg 1969; 59: 665-669.  Back to cited text no. 9    
10.Morris DL, Dykes PW. Mariner S et al. Albendazole - Objective evidence of response in human hydatid disease. JAMA 1985; 253: 2053-2057.  Back to cited text no. 10    
11.Halim A, Vaezzadeh K. Hydatid disease of the genitourinary tract. Br J Urol 1980; 52: 75-78.  Back to cited text no. 11    
12.Zmerli S, Ayed M. Arkam B. Hydatid cyst of the kidney. J Urol (Paris) 1980; 86: 519-526.  Back to cited text no. 12    
13.Benchekroun A, Lachkar A. Soumana A et al. Hydatid cyst of the kidney: report of 45 cases. Ann Urol (Paris) 1999: 33: 19-24.  Back to cited text no. 13    
14.Afsar H. Yagci F. Ayabasti N, Meto S. Hydatid disease of the kid­ney. BJU 1994; 73: 17-22.  Back to cited text no. 14    
15.Baykal K, Onal Y, Iseri C et al. Diagnosis and treatment of renal by­datid disease: presentation of four cases. Int J Urol 1996; 3: 497-500.  Back to cited text no. 15    
16.Odev K, Kilinc M. Arslan A et al. Renal hydatid cysts and the evaluation of their radiologic images. Eur Urol 1996: 30: 40-49.  Back to cited text no. 16    
17.Novick AC. Partial nephrectomy for renal cell carcinoma. Urol Clin North Am 1987; 14: 419.  Back to cited text no. 17    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]
 
 
    Tables

  [Table - 1], [Table - 2]



 

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    Introduction
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