The role of laparoscopic cyst decortication (LCD) in the treatment of autosomal dominant policystic kidney disease (AD PKD)
Article published in Urologia Polska 2007/60/4.
Mieczysław Fryczkowski, Jacek Huk, Andrzej Kupilas, Aleksandra Sitko-Saucha
- Katedra i Klinika Urologii w Zabrzu ¦l±skiej Akademii Medycznej w Katowicach
kidney, symptomatic AD PKD, laparoscopy, cyst decortication
Introduction. Decortication of many cysts in patients with AD PKD allows to reduce renal mass, decreases hydrostatic pressure in cysts moreover diminish pain.
Material and methods. Between September 2000 and July 2005 15 patients underwent LCD inculuding 5 (33.3%) men and 10 (66.7%) women with mean age of 54 years. 2 patients underwent extraperitoneal and 13 transperitoneal LCD. In 2 patients there were bilateral and in others unilateral decortication. Except for 3 patients 3 ports were used during the operation. Pain intensity was estimated in VAS 10 degree score. Renal function was estimated by GFR and renal dynamic Tc99 scintigraphy. All patients were diagnosed
- and followed-up with CT. Follow-up after LCD was 9 to 77 months (mean 36 months).
Results. Mean operation time was 197 min, mean hospitalization time 5.4 days, mean reconvalescence time 10,5 days. The mean number of operated cysts was 34.5 per one patient. Pain was relieved in all patients after LCD though it recurred in 26.7% with intensity
- under 29%. Mean renal function (GFR) and blood flow increases were observed in 10% and 4.9% of patients respectively.
Conclusions. 1. LCD in patients with symptomatic AD PKD is safe, effective and repeatable alternative to non-radical open surgery. 2. LDT stabilizes renal function which together with improved renal perfusion and renal decontamination decrease number of severe, life threatening complications. 3. LDT, like the other methods of non-radical AKD PKD treatment used today, is not the specific treatment. However, it allows to reduce significantly pain for the period of 2-3 years. In smaller extent it also improves the objective laboratorial and clinical results, what makes for the time being the kidney replacement treatment or kidney transplantation unnecessary.
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