Sinus Cyst Of The Kidney: Causes, Treatment, Photo

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Sinus cyst of the kidney

The content of the article:

1. Types of renal cysts

2. What is a sinus cyst

   Classification

3. The reasons

4. Treatment

   1. Drug treatment
   2. Surgery
5. Video

Parapelvic, or sinus cyst of the kidney is a type of simple cyst and for this reason is represented by a single formation. In the presence of signs of several cystic formations, it is necessary to carry out differential diagnosis with multicystic or polycystic disease.

Sinus cyst of the kidney can be diagnosed at any age, including children

Types of renal cysts

Cystic formations are divided depending on the localization in the kidney tissues:

• sinus - located in the area of the gate of the organ;
• parenchymal - located in the thickness of the tissues (not associated with the excretory ducts);
• subcapsular - located in the kidney capsule.

What is a sinus cyst

The neoplasm is located in the pelvis and affects the sinuses (intra-sinus location).

Disease characteristics:

• a sinusoidal arrangement can lead to a disruption of the collector system of the kidney (a violation of the normal outflow of urine and the development of renal failure);
• there is no correlation dependence on age (the adult and child population falls ill with almost the same frequency);
• both kidneys are rarely affected;
• symptoms occur infrequently, only at large sizes (more than 5 cm);
• the classic diagnostic method is ultrasound.

Pathology has a favorable prognosis in 80% of cases.

Classification

In urological practice, renal sinus cysts are usually assessed according to the Bosniak classification to determine further treatment tactics. This classification evaluates any cystic formation by external signs in accordance with a photo obtained using computed tomography.

A type	Character	Criteria
Bosniak I	Classic simple (benign with 0% malignancy)	1. More often single. 2. Rounded shape. 3. Soft elastic without additional inclusions. 4. Dense fibrous membrane. 5. Serous contents. 6. Does not accumulate contrast during examination (no signs of obturation). 7. The contours are smooth. They only require supervision.
Bosniak II	The structure becomes more complex (0% malignancy)	1. There are partitions (one or two). 2. Thin-walled (up to 1 mm). 3. There are single inclusions (calcifications). 4. Does not accumulate contrast in the study of renal function (there are no signs of obstruction and there is no violation of excretory function). 5. Serous contents mixed with blood or protein. 6. Size no more than 3 cm. They only require observation and control of ultrasound once a year.
Bosniak II F	A special subcategory with 5% malignancy (signs are ahead of groups I and II, but do not reach III)	1. A large number of partitions, which are uniformly thickened. 2. The walls of the cyst and septa may have calcifications. 3. Practically does not accumulate contrast during examination (slight signs of obturation). They only require observation and control of ultrasound every six months.
Bosniak III	Formations of a doubtful nature with malignancy up to 50% (precancer)	1. The wall is dense. 2. Calcification is uneven over the entire area of formation. 3. Multi-chamber. 4. Multiple partitions. 5. Explicitly filled with contrast agent during examination. 6. Protein or hemorrhagic content. They require planned surgical treatment.
Bosniak IV	Malignant education (malignancy 90-100%).	1. Degeneration of the contents (tissue component in the cavity). 2. Walls of different thickness. 3. Contrast builds up unevenly. An urgent surgical intervention is required (due to the risk of developing acute renal failure).

The parapelvic cyst rarely extends beyond the Bosniak I group.

The reasons

The pathogenesis is based on the compression of tissues from the neurovascular bundle and, as a consequence, their gradual atrophy with impairment of the normal excretory function of the kidney.

Predisposing reasons:

1. Inflammatory kidney disease (pyelonephritis). This group is of particular importance for protracted forms of infectious processes, since acute pathology does not lead to morphological changes in the kidney tissue.
2. Obstructive diseases of the urinary system (urolithiasis). In this case, the formation of cysts is caused by the difficulty in the outflow of urine and, as a result, the expansion of the pelvis and calyces (pseudocyst). Blockage of the excretory ducts can occur at any level (ureters, bladder).
3. Chronic kidney disease (urolithiasis). In addition to obturation, stones can mechanically damage the kidney tissue during movement. This contributes to the formation of "pockets" and the emergence of cystic formations in the future. In this case, the symptoms (sharp pain, renal colic) will be associated with the underlying disease.
4. Genetic predisposition. The presence of cysts in the fetus can be seen on screening ultrasound during pregnancy (II-III trimester). Simple cysts are not an indication for abortion. In this case, the cyst will refer to congenital malformations (observation by a urologist and pediatrician once a year with ultrasound control is shown). In children, surgical intervention is carried out in extreme cases and only after 6 months in accordance with the indications (growth, clinic, laboratory and instrumental data).
5. Cardiovascular disease. In particular, when blood pressure rises to high values (200/160 and above), a sharp impairment of blood circulation in the kidneys occurs with an increase in pressure in the renal arteries and veins. This condition can lead to increased filtration and expansion of the pyelocaliceal system with the formation of cystic cavities.
6. Excess weight leads to an increased load on the excretory system and significantly increases the filtration activity of the kidneys.
7. Traumatic injuries. Indirectly contribute to the development of a true cyst. In acute trauma, post-traumatic formations or ruptures (other nosological forms) are more often formed.

Only general facts are given that determine the occurrence of cystic formations, since the true cause has not been established.

Treatment

The tactics of treating cystic neoplasms depends on the Bosniak group.

Drug treatment

Conservative therapy is used only symptomatically:

• antibiotic therapy (in case of signs of infection) - Furazidin, Fosfomycin, Cefepim, Gentamicin sulfate;
• antihypertensive drugs (pressure reduction) - Captopril, Enalapril, Veropamil;
• analgesics (to relieve pain) - Drotaverin, Analgin;
• non-steroidal anti-inflammatory drugs - Ibuprofen;
• diuretics (only in the presence of clinical manifestations and doctor's prescription) - Furosemide.

Surgery

Indications for surgery:

• large sizes (more than 5 cm);
• gap;
• accession of a secondary infection and suppuration;
• changes in the general analysis of urine that do not go away after conservative therapy (a large number of red blood cells);
• not relieved arterial hypertension, but only if it is caused by cystic formation;
• signs of a malignant process.

Some kidney cysts require surgical removal

The following surgical options are used (the choice depends on the characteristics of the cyst):

View	Characteristic
Percutaneous puncture with content aspiration and sclerotherapy	It is carried out strictly under ultrasound control. The sclerosant is injected into the cavity in order to prevent recurrence. Puncture is permissible only for small formations. For sinus cysts, they are rarely used due to the peculiarities of their location (there is a high probability of trauma to healthy tissues).
Open resection (removal)	By technique, it refers to abdominal operations. It is optimal to use it when the cyst is located near the vessels and with a pronounced violation of the outflow of urine. Partial resection of the kidney is performed (gentle excision of the surrounding tissues). Nephrectomy (complete removal of the kidney) is performed only in the case of polycystic or multicystosis.
Laparoscopic removal	The technique is identical to the open technique (hatching), but this version uses high-tech devices (video monitors, laparoscope, trocars). Instruments are inserted into special points on the anterior abdominal wall and lateral surface of the abdomen. Has a shorter postoperative period and lower risks.

All surgical interventions have risks:

1. At the intraoperative stage. When the formation is husked, injury to the calyx-pelvic system is possible, which leads to impaired renal function. With insufficient hemostasis and vascular ligation, severe bleeding may occur (especially if the renal artery or abdominal aorta is damaged). In addition, uric acid salts can be deposited on the suture material with the formation of stones (suture material dissolves in 30-60-90 days).
2. In the postoperative period, bleeding is possible (usually not pronounced). Bleeding arises from the tissues of the kidney, not the large vessels. It is also possible the occurrence of hematomas of the retroperitoneal space. In extremely rare cases, cysts recur.

Complications during surgery are relatively rare (sufficient access to the organ and the latest techniques reduce risks to a minimum).

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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