|Year : 2001 | Volume
| Issue : 2 | Page : 167-169
A feasible approach to renal hydatid cyst: Presentation of two cases and review of literature
NP Gupta, MS Ansari, Igbal Singh
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
N P Gupta
Department of Urology, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
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 Jun 25];17:167-9. Available from: http://www.indianjurol.com/text.asp?2001/17/2/167/20264
| Introduction|| |
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.  From India there have been anecdotal case reports of renal hydatid disease. ,, 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|| |
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|| |
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.  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.  Among the radiological investigations CT scan is more sensitive and accurate than ultrasonography. Accuracy of CT has been reported to be more than 90%.  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. , 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.  Post-operatively albendazole has shown to reduce the risk of implantation of scolices.  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.  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%.  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.  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.  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. ,, 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.  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|| |
|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. |
|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. |
|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. |
|4.||Mukherji AK, Mukherji S, Sen JK. Renal hydatid cyst presenting with hypertension. J Assoc Physicians India 1976: 24: 49-51. |
|5.||Buckley RJ, Smith S, Hershorn S. Echinococcal disease of the kidney presenting a renal filling defect. J Urol 1985: 133: 1660-1661. |
|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. |
|7.||Roylance J. Davies ER, Alexender WD. Traumatic puncture of renal hydatid cyst. Br J Radiol 1973; 46: 960-963. |
|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. |
|9.||Hortan RJ. Chemotherapy of echinococcal infection in man with albendazole. Aust NZJ Surg 1969; 59: 665-669. |
|10.||Morris DL, Dykes PW. Mariner S et al. Albendazole - Objective evidence of response in human hydatid disease. JAMA 1985; 253: 2053-2057. |
|11.||Halim A, Vaezzadeh K. Hydatid disease of the genitourinary tract. Br J Urol 1980; 52: 75-78. |
|12.||Zmerli S, Ayed M. Arkam B. Hydatid cyst of the kidney. J Urol (Paris) 1980; 86: 519-526. |
|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. |
|14.||Afsar H. Yagci F. Ayabasti N, Meto S. Hydatid disease of the kidney. BJU 1994; 73: 17-22. |
|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. |
|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. |
|17.||Novick AC. Partial nephrectomy for renal cell carcinoma. Urol Clin North Am 1987; 14: 419. |
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2]