PDF icon Download PDF
Semin intervent Radiol 2011; 28(4): 380-391
DOI: 10.1055/s-0031-1296080
© Thieme Medical Publishers

Renal Cysts and Urinomas

Jessica Lee1 , Michael Darcy1
  • 1Mallinckrodt Institute of Radiology, St. Louis, Missouri
Further Information

Publication History

Publication Date:
03 January 2012 (online)

Also available ateRefMedOne
   Permissions and Reprints
Preview

ABSTRACT

Renal cysts are a common imaging finding. Although most cysts never have symptoms, some cause pain, collecting system compression, hematuria, hypertension, and secondary infection. The mere presence of a cyst is not an indication for intervention, but treatment may be indicated in symptomatic patients or those with secondary obstruction. Urinomas generally are a contained collection of urine outside of the normal pathways where urine travels. As such, urinomas can arise anywhere from the upper abdomen down into the low pelvis and have a variety of etiologies. Ureteral obstruction with forniceal rupture and trauma (blunt, penetrating, or iatrogenic) are the most common causes of urinomas. When urinomas arise spontaneously, the likely cause varies with the patient's age. Blunt or penetrating trauma can cause perinephric urinomas by two mechanisms—direct disruption of the pelvis or collecting system or by degeneration of nonviable tissue. These urinomas are often perinephric, but can also occur in a subcapsular location. This review will discuss diagnosis, classification, and treatment of renal cysts and urinomas.

KEYWORDS

Renal cysts - urinoma - interventional radiology - sclerosis - puncture

REFERENCES

  • 1 McHugh K, Stringer D A, Hebert D, Babiak C A. Simple renal cysts in children: diagnosis and follow-up with US.  Radiology. 1991;  178 (2) 383-385
    Search in Google Scholar
  • 2 Hartman D S, Weatherby III E, Laskin W B, Brody J M, Corse W, Baluch J D. Cystic renal cell carcinoma: CT findings simulating a benign hyperdense cyst.  AJR Am J Roentgenol. 1992;  159 (6) 1235-1237
    Search in Google Scholar
  • 3 Israel G M, Bosniak M A. An update of the Bosniak renal cyst classification system.  Urology. 2005;  66 (3) 484-488
    Search in Google Scholar
  • 4 Lang E K. Renal cyst puncture studies.  Urol Clin North Am. 1987;  14 (1) 91-102
    Search in Google Scholar
  • 5 Mosli H, MacDonald P, Schillinger J. Caliceal diverticula developing into simple renal cyst.  J Urol. 1986;  136 (3) 658-661
    Search in Google Scholar
  • 6 Grantham J J. Pathogenesis of renal cyst expansion: opportunities for therapy.  Am J Kidney Dis. 1994;  23 (2) 210-218
    Search in Google Scholar
  • 7 Patel K, Caro P A, Chatten J. Parapelvic renal cyst causing UPJ obstruction. Investigation by IVP, ultrasound and CT.  Pediatr Radiol. 1988;  19 (1) 2-5
    Search in Google Scholar
  • 8 Mishal J, Lebovici O, Bregman L, London D, Yoffe B, Sherer Y. Huge renal arteriovenous malformation mimicking simple parapelvic cyst.  Clin Imaging. 2000;  24 (3) 166-168
    Search in Google Scholar
  • 9 Kwon H S, Shin S J, Yun S N, Yang C W, Chang Y S, Bang B K. Renal artery aneurysm manifested as parapelvic cyst on abdominal sonography.  Nephron. 1996;  74 (1) 229
    Search in Google Scholar
  • 10 Amis Jr E S, Cronan J J. The renal sinus: an imaging review and proposed nomenclature for sinus cysts.  J Urol. 1988;  139 (6) 1151-1159
    Search in Google Scholar
  • 11 Whelan T F. Guidelines on the management of renal cyst disease.  Can Urol Assoc J. 2010;  4 (2) 98-99
    Search in Google Scholar
  • 12 Hughes C R, Stewart Jr P F, Breckenridge J W. Renal cyst rupture following blunt abdominal trauma: case report.  J Trauma. 1995;  38 (1) 28-29
    Search in Google Scholar
  • 13 Papanicolaou N, Pfister R C, Yoder I C. Spontaneous and traumatic rupture of renal cysts: diagnosis and outcome.  Radiology. 1986;  160 (1) 99-103
    Search in Google Scholar
  • 14 Davis III J M, McLaughlin A P. Spontaneous renal hemorrhage due to cyst rupture: CT findings.  AJR Am J Roentgenol. 1987;  148 (4) 763-764
    Search in Google Scholar
  • 15 Blakeley C J, Thiagalingham N. Spontaneous retroperitoneal haemorrhage from a renal cyst: an unusual cause of haemorrhagic shock.  Emerg Med J. 2003;  20 (4) 388
    Search in Google Scholar
  • 16 Lin Y Y, Chen J D, How C K, Yen D H. Spontaneous perinephric hemorrhage from a hemorrhagic renal cyst.  Intern Med. 2010;  49 (19) 2189-2190
    Search in Google Scholar
  • 17 Zerem E, Imamović G, Omerović S. Simple renal cysts and arterial hypertension: does their evacuation decrease the blood pressure?.  J Hypertens. 2009 October 2009;  27 (10) 2074-2078
    Search in Google Scholar
  • 18 Pearl M, Klein S. Simple renal cyst and hypertension.  Ann Radiol (Paris). 1986;  29 (3-4) 421-423
    Search in Google Scholar
  • 19 de Lichtenberg M H, Nielsen O S. Infected renal cyst simulating acute abdomen. Case report.  Acta Chir Scand. 1989;  155 (2) 135
    Search in Google Scholar
  • 20 Ohkawa M, Motoi I, Hirano S, Okasho A, Hisazumi H. Biochemical and pharmacodynamic studies of simple renal cyst fluids in relation to infection.  Nephron. 1991;  59 (1) 80-83
    Search in Google Scholar
  • 21 Fortner A, Taylor Jr A, Alazraki N, Datz F L. Advantage of indium-111 leukocytes over ultrasound in imaging an infected renal cyst.  J Nucl Med. 1986;  27 (7) 1147-1149
    Search in Google Scholar
  • 22 Chicoskie C, Chaoui A, Kuligowska E, Dember L M, Tello R. MRI isolation of infected renal cyst in autosomal dominant polycystic kidney disease.  Clin Imaging. 2001;  25 (2) 114-117
    Search in Google Scholar
  • 23 Akinci D, Akhan O, Ozmen M et al.. Long-term results of single-session percutaneous drainage and ethanol sclerotherapy in simple renal cysts.  Eur J Radiol. 2005;  54 (2) 298-302
    Search in Google Scholar
  • 24 Newhouse J H, Pfister R C. Renal cyst puncture. In: Anthasoulis C A, Pfister R C, Greene R E, Roberson G H, eds. Interventional Radiology. Philadelphia: Saunders; 1982: 409-425
    Search in Google Scholar
  • 25 Sandler C M. Renal cyst puncture and percutaneous drainage of perirenal fluid. In: Kadir S, ed. Current practice of interventional radiology. Philadelphia: Decker; 1991: 662-668
    Search in Google Scholar
  • 26 Lang E K. Coexistence of cyst and tumor in the same kidney.  Radiology. 1971;  101 (1) 7-16
    Search in Google Scholar
  • 27 Lang E K. The differential diagnosis of renal cysts and tumors. Cyst puncture, aspiration, and analysis of cyst content for fat as diagnostic criteria for renal cysts.  Radiology. 1966;  87 (5) 883-888
    Search in Google Scholar
  • 28 Ljungberg B, Holmberg G, Sjödin J G, Hietala S O, Stenling R. Renal cell carcinoma in a renal cyst: a case report and review of the literature.  J Urol. 1990;  143 (4) 797-799
    Search in Google Scholar
  • 29 Kleist H, Jonsson O, Lundstam S, Nauclér J, Nilson A E, Pettersson S. Quantitative lipid analysis in the differential diagnosis of cystic renal lesions.  Br J Urol. 1982;  54 (5) 441-445
    Search in Google Scholar
  • 30 Kavoussi L R, Clayman R V, Mikkelsen D J, Meretyk S. Ureteronephroscopic marsupialization of obstructing peripelvic renal cyst.  J Urol. 1991;  146 (2) 411-414
    Search in Google Scholar
  • 31 Lang E K. Renal cyst puncture and aspiration: a survey of complications.  AJR Am J Roentgenol. 1977;  128 (5) 723-727
    Search in Google Scholar
  • 32 Zelch J, Lalli A F, Stewart B H, Daughtry J D. Complications of renal cyst exploration versus renal mass aspiration.  Urology. 1976;  7 (3) 244-247
    Search in Google Scholar
  • 33 Clayman R V, Surya V, Miller R P, Reinke D B, Fraley E E. Pursuit of the renal mass. Is ultrasound enough?.  Am J Med. 1984;  77 (2) 218-223
    Search in Google Scholar
  • 34 von Schreeb T, Arner O, Skovsted G, Wikstad N. Renal adenocarcinoma. Is there a risk of spreading tumour cells in diagnostic puncture?.  Scand J Urol Nephrol. 1967;  1 (3) 270-276
    Search in Google Scholar
  • 35 Jacobsson L, Lindqvist B, Michaelson G, Bjerle P. Fluid turnover in renal cysts.  Acta Med Scand. 1977;  202 (4) 327-329
    Search in Google Scholar
  • 36 Wahlqvist L, Grumstedt B. Therapeutic effect of percutaneous puncture of simple renal cyst. Follow-up investigation of 50 patients.  Acta Chir Scand. 1966;  132 (4) 340-347
    Search in Google Scholar
  • 37 Ozgür S, Cetin S, Ilker Y. Percutaneous renal cyst aspiration and treatment with alcohol.  Int Urol Nephrol. 1988;  20 (5) 481-484
    Search in Google Scholar
  • 38 Holmberg G, Hietala S O. Treatment of simple renal cysts by percutaneous puncture and instillation of bismuth-phosphate.  Scand J Urol Nephrol. 1989;  23 (3) 207-212
    Search in Google Scholar
  • 39 Bean W J. Renal cysts: treatment with alcohol.  Radiology. 1981;  138 (2) 329-331
    Search in Google Scholar
  • 40 Reiner I, Donnell S, Jones M, Carty H L, Richwood A M. Percutaneous sclerotherapy for simple renal cysts in children.  Br J Radiol. 1992;  65 (771) 281-282
    Search in Google Scholar
  • 41 Raskin M M, Poole D O, Roen S A, Viamonte Jr M. Percutaneous management of renal cysts: results of a four-year study.  Radiology. 1975;  115 (3) 551-553
    Search in Google Scholar
  • 42 Pfister R C, Schaffer D. Percutaneous ablation of renal cysts.  AJR Am J Roentgenol. 1979;  132 1031
    Search in Google Scholar
  • 43 Gelet A, Sanseverino R, Martin X, Leveque J M, Dubernard J M. Percutaneous treatment of benign renal cysts.  Eur Urol. 1990;  18 (4) 248-252
    Search in Google Scholar
  • 44 Phelan M, Zajko A, Hrebinko R L. Preliminary results of percutaneous treatment of renal cysts with povidone-iodine sclerosis.  Urology. 1999;  53 (4) 816-817
    Search in Google Scholar
  • 45 Kim S H, Moon M W, Lee H J, Sim J S, Kim S H, Ahn C. Renal cyst ablation with n-butyl cyanoacrylate and iodized oil in symptomatic patients with autosomal dominant polycystic kidney disease: preliminary report.  Radiology. 2003;  226 (2) 573-576
    Search in Google Scholar
  • 46 Choi Y D, Ham W S, Kim W T et al.. Clinical experience of single-session percutaneous aspiration and OK-432 sclerotherapy for treatment of simple renal cysts: 1-year follow-up.  J Endourol. 2009;  23 (6) 1001-1006
    Search in Google Scholar
  • 47 Demir E, Alan C, Kilciler M, Bedir S. Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst.  J Endourol. 2007;  21 (8) 903-905
    Search in Google Scholar
  • 48 Egilmez H, Gok V, Oztoprak I et al.. Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst.  Korean J Radiol. 2007;  8 (6) 512-519
    Search in Google Scholar
  • 49 Yamamoto K, Sakaguchi H, Anai H et al.. Sclerotherapy for simple cysts with use of ethanolamine oleate: preliminary experience.  Cardiovasc Intervent Radiol. 2005;  28 (6) 751-755
    Search in Google Scholar
  • 50 Yoo K H, Lee S J, Jeon S H. Simple renal cyst sclerotherapy with acetic acid: our 10-year experience.  J Endourol. 2008;  22 (11) 2559-2563
    Search in Google Scholar
  • 51 Xu X X, Du Y, Yang H F, Zhang Q, Li Y, Zee C S. CT-guided sclerotherapy with ethanol concentration monitoring for treatment of renal cysts.  AJR Am J Roentgenol. 2011;  196 (1) W78-82
    Search in Google Scholar
  • 52 Fontana D, Porpiglia F, Morra I, Destefanis P. Treatment of simple renal cysts by percutaneous drainage with three repeated alcohol injection.  Urology. 1999;  53 (5) 904-907
    Search in Google Scholar
  • 53 Delakas D, Karyotis I, Loumbakis P, Daskalopoulos G, Charoulakis N, Cranidis A. Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts.  Int Urol Nephrol. 2001;  32 (3) 321-326
    Search in Google Scholar
  • 54 Paananen I, Hellström P, Leinonen S et al.. Treatment of renal cysts with single-session percutaneous drainage and ethanol sclerotherapy: long-term outcome.  Urology. 2001;  57 (1) 30-33
    Search in Google Scholar
  • 55 Zerem E, Imamovíc G, Omerovíc S. Symptomatic simple renal cyst: comparison of continuous negative-pressure catheter drainage and single-session alcohol sclerotherapy.  AJR Am J Roentgenol. 2008;  190 (5) 1193-1197
    Search in Google Scholar
  • 56 Camacho M F, Bondhus M J, Carrion H M, Lockhart J L, Politano V A. Ureteropelvic junction obstruction resulting from percutaneous cyst puncture and intracystic isophendylate injection: an unusual complications.  J Urol. 1980;  124 (5) 713-714
    Search in Google Scholar
  • 57 Peyromaure M, Debré B, Flam T A. Sclerotherapy of a giant renal cyst with povidone-iodine.  J Urol. 2002;  168 (6) 2525
    Search in Google Scholar
  • 58 Madeb R, Feldman P A, Knopf J, Rub R, Erturk E, Yachia D. Povidone-iodine sclerotherapy is ineffective in the treatment of symptomatic renal cysts.  J Endourol. 2006;  20 (6) 402-404
    Search in Google Scholar
  • 59 Meng M V, Grossfeld G D, Stoller M L. Renal carcinoma after laparoscopic cyst decortication.  J Urol. 2002;  167 (3) 1396
    Search in Google Scholar
  • 60 Nieh P T, Bihrle III W. Laparoscopic marsupialization of massive renal cyst.  J Urol. 1993;  150 (1) 171-173
    Search in Google Scholar
  • 61 Morgan Jr C, Rader D. Laparoscopic unroofing of a renal cyst.  J Urol. 1992;  148 (6) 1835-1836
    Search in Google Scholar
  • 62 Hulbert J C. Laparoscopic management of renal cystic disease.  Semin Urol. 1992;  10 (4) 239-241
    Search in Google Scholar
  • 63 Amar A D, Das S. Surgical management of benign renal cysts causing obstruction of renal pelvis.  Urology. 1984;  24 (5) 429-433
    Search in Google Scholar
  • 64 Atug F, Burgess S V, Ruiz-Deya G, Mendes-Torres F, Castle E P, Thomas R. Long-term durability of laparoscopic decortication of symptomatic renal cysts.  Urology. 2006;  68 (2) 272-275
    Search in Google Scholar
  • 65 Roberts W W, Bluebond-Langner R, Boyle K E, Jarrett T W, Kavoussi L R. Laparoscopic ablation of symptomatic parenchymal and peripelvic renal cysts.  Urology. 2001;  58 (2) 165-169
    Search in Google Scholar
  • 66 Hoenig D M, McDougall E M, Shalhav A L, Elbahnasy A M, Clayman R V. Laparoscopic ablation of peripelvic renal cysts.  J Urol. 1997;  158 (4) 1345-1348
    Search in Google Scholar
  • 67 Hulbert J C, Hunter D, Young A T, Castaneda-Zuniga W. Percutaneous intrarenal marsupialization of a perirenal cystic collection—endocystolysis.  J Urol. 1988;  139 (5) 1039-1041
    Search in Google Scholar
  • 68 Kang Y, Noble C, Gupta M. Percutaneous resection of renal cysts.  J Endourol. 2001;  15 (7) 735-738 discussion 738-739
    Search in Google Scholar
  • 69 Heikkilä J, Taskinen S, Rintala R. Urinomas associated with posterior urethral valves.  J Urol. 2008;  180 (4) 1476-1478
    Search in Google Scholar
  • 70 Umbreit E C, Routh J C, Husmann D A. Nonoperative management of nonvascular grade IV blunt renal trauma in children: meta-analysis and systematic review.  Urology. 2009;  74 (3) 579-582
    Search in Google Scholar
  • 71 Boone T B, Gilling P J, Husmann D A. Ureteropelvic junction disruption following blunt abdominal trauma.  J Urol. 1993;  150 (1) 33-36
    Search in Google Scholar
  • 72 Bennett L N, Voegeli D R, Crummy A B, McDermott J C, Jensen S R, Sollinger H W. Urologic complications following renal transplantation: role of interventional radiologic procedures.  Radiology. 1986;  160 (2) 531-536
    Search in Google Scholar
  • 73 Alkibay T, Karaoğlan U, Gündoğdu S, Bozkirli I. An unusual complication of extracorporeal shock wave lithotripsy: urinoma due to rupture of the renal pelvis.  Int Urol Nephrol. 1992;  24 (1) 11-14
    Search in Google Scholar
  • 74 Portela L A, Patel S K, Callahan D H. Pararenal pseudocyst (urinoma) as complication of percutaneous nephrostomy.  Urology. 1979;  13 (5) 570-571
    Search in Google Scholar
  • 75 Rajendran L J, Rao M S, Bapna B C et al.. Peripelvic extravasation and formation of perinephric urinoma after cystoscopy.  Urology. 1980;  16 (2) 199-201
    Search in Google Scholar
  • 76 Oefelein M G. Delayed presentation of urinoma after radiofrequency ablation-assisted laparoscopic partial nephrectomy.  J Endourol. 2006;  20 (1) 27-30
    Search in Google Scholar
  • 77 Testa A C, Gaurilcikas A, Licameli A et al.. Sonographic imaging of urinoma.  Ultrasound Obstet Gynecol. 2009;  33 (4) 490-491
    Search in Google Scholar
  • 78 Titton R L, Gervais D A, Hahn P F, Harisinghani M G, Arellano R S, Mueller P R. Urine leaks and urinomas: diagnosis and imaging-guided intervention.  Radiographics. 2003;  23 (5) 1133-1147
    Search in Google Scholar
  • 79 Cullmann H J, Prosinger M. Necrosis of the allograft ureter—evaluation of different examination methods in early diagnosis.  Urol Int. 1990;  45 (3) 164-169
    Search in Google Scholar
  • 80 Smith T P, Hunter D W, Letourneau J G et al.. Urine leaks after renal transplantation: value of percutaneous pyelography and drainage for diagnosis and treatment.  AJR Am J Roentgenol. 1988;  151 (3) 511-513
    Search in Google Scholar
  • 81 Kinnaert P, Hall M, Janssen F, Vereerstraeten P, Toussaint C, Van Geertruyden J. Ureteral stenosis after kidney transplantation: true incidence and long-term followup after surgical correction.  J Urol. 1985;  133 (1) 17-20
    Search in Google Scholar
  • 82 Maillet P J, Pelle-Francoz D, Leriche A, Leclercq R, Demiaux C. Fistulas of the upper urinary tract: percutaneous management.  J Urol. 1987;  138 (6) 1382-1385
    Search in Google Scholar
  • 83 Anderson H, Alyas F, Edwin P J. Intra-urinoma rendezvous using a transconduit approach to re-establish ureteric integrity.  Cardiovasc Intervent Radiol. 2005;  28 (1) 95-97
    Search in Google Scholar
  • 84 Horikami K, Matsuoka Y, Nagaoki K et al.. Treatment of post-traumatic urinoma by means of selective arterial embolization.  J Vasc Interv Radiol. 1997;  8 (2) 221-224
    Search in Google Scholar
  • 85 Pinto I T, Chimeno P C. Treatment of a urinoma and a post-traumatic pseudoaneurysm using selective arterial embolization.  Cardiovasc Intervent Radiol. 1998;  21 (6) 506-508
    Search in Google Scholar
  • 86 Spurlock J W, Burke T W, Dunn N P, Heller P B, Collins H S, Park R C. Calyceal rupture with perirenal urinoma in a patient with cervical carcinoma.  Obstet Gynecol. 1987;  70 (3 Pt 2) 511-513
    Search in Google Scholar
  • 87 Lang E K, Glorioso III L. Management of urinomas by percutaneous drainage procedures.  Radiol Clin North Am. 1986;  24 (4) 551-559
    Search in Google Scholar
  • 88 Kobayashi K, Censullo M L, Rossman L L, Kyriakides P N, Kahan B D, Cohen A M. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations.  Radiographics. 2007;  27 (4) 1109-1130
    Search in Google Scholar
  • 89 Aning J J, Stott M A, Watkinson A F. Glue ablation of a late-presentation urinary fistula after partial nephrectomy.  Br J Radiol. 2009;  82 (984) e246-e248
    Search in Google Scholar

Michael DarcyM.D. 

Mallinckrodt Institute of Radiology

510 South Kingshighway Blvd., St. Louis, MO 63110

Email: darcym@mir.wustl.edu