To evaluate the orientated function and advantages of methylene blue(MB) staining of renal cyst-wall with the help of percutaneous renal directly puncture guided by B ultrasound for parapelvic cyst within flexible ureteroscopy.
From February 2014 to March 2017, 19 patients who underwent minimally invasive surgery for parapelvic cyst at our center were included. According to the differences of operation method, The datas were divided into 2 groups: group MB-FUR-IDPC (flexible ureteroscopic holmium laser incision and drainage for parapelvic cyst with methylene blue staining) included 9 patients, group NMB-FUR-IDPC (flexible ureteroscopic holmium laser incision and drainage for parapelvic cyst with non-methylene blue staining) included 10 patients. Baseline clinical features, including sex, symptom and cyst size, were comparable between the two cohorts (P-values > 0.05). The time of preoperative Double-J ureteral stenting, the time of operation, the rate of successful orientation of cyst, the total length of hospital stay and the length of postoperative hospital stay between the two groups were analyzed and compared.
19 cases were operated successfully. Preoperative Double-J ureteral stenting time of NMB-FUR-IDPC and MB-FUR-IDPC were: 5.9±1.0 days and 3.9±2.6 days, respectively. 2 cases of MB-FUR-IDPC without using preoperative Double-J ureteral stenting, and the other 2 cases of MB-FUR-IDPC indwelled preoperative Double-J tube for only 3 days, with statistically significantly between the two groups (P-values < 0.05); the operation time and hospitalization time : 55.4±22.5min and 9.4±2.4 days for group NMB-FUR-IDPC and a statistically significantly more than group MB-FUR-IDPC (28.67±8.4min and 6.8±1.8 days); with intraoperative orientation of cyst failure under flexible ureteroscopy for 2 cases of NMB-FUR-IDPC, and then alterlative treatment approach of percutaneous renal holmium laser incision drainage were successfully performed. Postoperative hospitalization time were similarly 3.5±2.2 days for NMB-FUR-IDPC and 2.3±0.5days for MB-FUR-IDPC, respectively. Follow up for 1-36 months showed no recurrence. Conclusion Methylene blue staining of renal cyst-wall with the help of percutaneous renal directly puncture guided by B ultrasound can well locate parapelvic cyst under the condition of indwelling or shorter preoperatively indwelling Double-J tube time, with the advantages of improving the achievement ratio of one stage operation, shortening the operation time, and reducing hospitalization time.
Posted by: Zhixian WANG, graduate student, Tongji Hospital Affiliated to Huazhong University of Science and Technology, China (24-Jun-2017)