Summary
Introduction
We report a case of a right parapelvic renal cyst causing intermittent ureteropelvic
junction obstruction (UPJO).
Diagnostic evaluation
A 13-year-old male was referred for right flank pain. Stone protocol CT revealed renal
pelvis dilation with punctate stones. Due to concern for intermittently obstructive
calculi, he underwent ureteroscopy, which was unremarkable. A diuretic renogram showed
symmetric uptake with partial emptying on the right with pain after diuretic administration.
In office, we potentiated a Dietl's crisis with ultrasound obtained before and after
fluid intake. Comparison of ultrasounds revealed a parapelvic cyst causing calyceal
dilation. He was counseled for robotic cyst decortication and possible pyeloplasty.
Surgical considerations
A robotic cyst decortication was performed. Once decorticated, the cyst base was fulgurated
and pararenal fat was interposed into the cyst base. Console time was 70 min with
minimal blood loss. The patient was discharged post-operative day 1. Follow-up renal
ultrasound at 4 months demonstrated resolution of hydronephrosis and parapelvic cyst.
Conclusion
Parapelvic renal cysts causing intermittent UPJO is a rare entity that may be missed
on a diuretic renogram. Clinical suspicion and appropriate imaging with ultrasound
or magnetic resonance imaging are useful. Robotic cyst decortication is a technically
feasible approach to treat this condition.
Keywords
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References
- A peripelvic renal cyst resulting in clinically symptomatic ureteropelvic junction obstruction.Urol Case Rep. 2018; 16: 69-71https://doi.org/10.1016/j.eucr.2017.11.001
- Laparoscopic ablation of symptomatic peripelvic renal cysts.J Endourol. 2004; 18: 45-48https://doi.org/10.1089/089277904322836668
- Para-pelvic cyst- an unusual cause of pelviureteric obstruction in a malrotated kidney.Urol Case Rep. 2021; 34: 101454https://doi.org/10.1016/j.eucr.2020.101454
- Laparoscopic management of peripelvic renal cysts: University of California, San Francisco experience and review of literature.Urology. 2005; 65: 882-887https://doi.org/10.1016/j.urology.2004.11.012
- Parapelvic renal cyst causing UPJ obstruction.Pediatr Radiol. 1988; 19: 2-5https://doi.org/10.1007/BF02388397
Article info
Publication history
Published online: August 16, 2021
Accepted:
August 10,
2021
Received:
March 18,
2021
Identification
Copyright
© 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
