Advertisement

Parapelvic cyst: A rare cause of ureteropelvic junction obstruction in a pediatric patient managed with robotic cyst decortication

  • Jennifer M. Lovin
    Correspondence
    Correspondence to: Jennifer M. Lovin, Section of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, 5730 Glenridge Drive, NE, Atlanta, GA, USA, Tel.: +1 770 490 5019
    Affiliations
    Section of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, 5730 Glenridge Drive, NE, Atlanta, GA, USA
    Search for articles by this author
  • Andrew J. Kirsch
    Affiliations
    Section of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, 5730 Glenridge Drive, NE, Atlanta, GA, USA
    Search for articles by this author
  • Shuvro De
    Affiliations
    Section of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, 5730 Glenridge Drive, NE, Atlanta, GA, USA
    Search for articles by this author

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Coggins W.
        • Hudgins H.
        • Kosarek C.
        • Roberts R.
        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
        • Doumas K.
        • Skrepetis K.
        • Lykourinas M.
        Laparoscopic ablation of symptomatic peripelvic renal cysts.
        J Endourol. 2004; 18: 45-48https://doi.org/10.1089/089277904322836668
        • Khalid M.
        • Javed M.
        • Shahzad K.
        • Mirza I.
        • Khan U.
        • Siqqiqi U.
        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
        • Affonso H.
        • Cooperberg M.
        • Ershoff B.
        • Rubenstein J.
        • Meng M.
        • Stoller M.
        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
        • Patel K.
        • Caro P.A.
        • Chatten J.
        Parapelvic renal cyst causing UPJ obstruction.
        Pediatr Radiol. 1988; 19: 2-5https://doi.org/10.1007/BF02388397