U J 03 - All-2.pdf 606 | Point Of Technique PCNL Approach for Treatment of Hydatid Cysts of the Kidney A New Percutaneous Treatment Youness El Harrech, Najib Abbaka, Omar Ghoundale, Driss Touiti Corresponding Author: Youness El Harrech, MD Service d’Urologie, Hôpital Militaire Avicenne, Mar- rakech, Morocco Tel: +21 266 132 6160 E-mail: youness.elhar- rech@gmail.com Received November 2011 Accepted April 2012 Department of Urology, Military Hospital Avicenne, Marrakech, Morocco POINT OF TECHNIQUE Keywords: INTRODUCTION ydatid disease, caused by Echinococcus granulosus, is a common health problem in - ity.(1) rare, comprising only 2% to 4% of all cases.(2) (3,4) Mebendazole and albendazole have been used as medical treatment, but their place in the man- agement of the hydatid cysts remains controversial(5,6) and large series for the medical treatment of renal hydatid disease are not available in literature. CASE REPORT - 607Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L Echinococ- cus granulosus. The patient refused any renal operation. Percutaneous inter- TECHNIQUE - - - - - under radiographic control. After the correct position of the structures embedded in gelatinous material came out of the - ably useful to do an electrocautery of the germinal layer PCNL for Renal Hydatid Cyst | El Harrech et al Figure 1. (A) Computed tomography of the abdomen demon- strating a large cystic lesion of left anterior renal cortex with a well-defined wall and daughter cysts within, (B) Computed to- mography scan showing the association between the cyst and the kidney. Figure 2. Fluoroscopic guidance. Opacification through the ure- teral catheter allowed direct puncture of the cyst with fine needle (arrow) without crossing the pelvicaliceal system. Arrow heads show the daughter cysts. 608 | months. The abdomen computed tomography scan repeated DISCUSSION There is no “best” treatment option for hydatid cyst and no clinical trial has compared all the different treatment mo- extrahepatic sites, the strength of recommendation is even - - cal recurrence of hydatid cyst after surgery reaches 30% and long hospitalization time after surgery is required.(4,7-9) - ment of renal hydatid cyst. Both, transperitoneal and retro- spillage occurs during the operation using the transperito- neal route.(10) about the results of laparoscopy, and further studies of the long-term outcomes are necessary. injection of a scolicidal agent, and re-aspiration), various extensive use, the puncture of echinococcal cysts is still controversial mainly because of fear of anaphylaxis. - neous treatment procedures, the overall fatality rate due to (11) Figure 3. (A) Multiple flimsy membranous structures embedded in gelatinous material came out of the sheath, (B) Hydatid mate- rial aspirated. Figure 4. Endoscopic view showing a daughter cyst grasped by the forceps. Point Of Technique 609Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L of medical and 0.01% of surgical inpatients. Antibiotics concerned therapeutic classes. The overall fatality and al- lergic reactions to radiographic contrast rates are 0.001% to 0.009% and 1%, respectively.(12) - lated to percutaneous treatment of hydatid cyst is an ex- tremely rare event and is observed no more frequently than drug-related anaphylactic side effects. - - tent might improve the success rate and prevent the recur- the drug of choice to treat hydatid cyst, either alone or to- (9) a fat-rich meal to increase its bioavailability, it should be - - toneal cysts. Some authors recommend using albendazole (13) Our patient received albendazole treatment regimen for three months. - sive, and does not require long hospitalization. When the - cur. The patient in this report had a huge hydatid cyst in the - - - CONFLICT OF INTEREST None declared. Figure 5. The abdominal computed tomography scan repeated after 10 months showed no recurrence of cyst with persistent densification of perirenal fat. REFERENCES 1. Vuitton DA. The WHO Informal Working Group on Echino- coccosis. Coordinating Board of the WHO-IWGE. Parassito- logia. 1997;39:349-53. 2. Gogus C, Safak M, Baltaci S, Turkolmez K. Isolated renal hy- datidosis: experience with 20 cases. J Urol. 2003;169:186-9. 3. Langer JC, Rose DB, Keystone JS, Taylor BR, Langer B. Diag- nosis and management of hydatid disease of the liver. A 15- year North American experience. Ann Surg. 1984;199:412-7. 4. Sielaff TD, Taylor B, Langer B. Recurrence of hydatid disease. World J Surg. 2001;25:83-6. 5. Todorov T, Vutova K, Mechkov G, Petkov D, Nedelkov G, Tonchev Z. Evaluation of response to chemotherapy of hu- man cystic echinococcosis. Br J Radiol. 1990;63:523-31. 6. Vutova K, Mechkov G, Vachkov P, et al. Effect of mebenda- zole on human cystic echinococcosis: the role of dosage and treatment duration. Ann Trop Med Parasitol. 1999;93:357- 65. 7. Schiller CF. Complications of echinococcus cyst rupture. A study of 30 cases. JAMA. 1966;195:220-2. 8. Saimot AG. Medical treatment of liver hydatidosis. World J Surg. 2001;25:15-20. PCNL for Renal Hydatid Cyst | El Harrech et al 610 | 9. Franchi C, Di Vico B, Teggi A. Long-term evaluation of pa- tients with hydatidosis treated with benzimidazole carba- mates. Clin Infect Dis. 1999;29:304-9. 10. Khan M, Sajjad Nazir S, Ahangar S, Farooq Qadri SJ, Ahmad Salroo N. Retroperitoneal laparoscopy for the management of renal hydatid cyst. Int J Surg. 2010;8:266-8. 11. Neumayr A, Troia G, de Bernardis C, et al. Justified concern or exaggerated fear: the risk of anaphylaxis in percutaneous treatment of cystic echinococcosis-a systematic literature review. PLoS Negl Trop Dis. 2011;5:e1154. 12. Vervloet D, Durham S. Adverse reactions to drugs. BMJ. 1998;316:1511-4. 13. Arif SH, Shams Ul B, Wani NA, et al. Albendazole as an adju- vant to the standard surgical management of hydatid cyst liver. Int J Surg. 2008;6:448-51. Point Of Technique