SURGICAL-MANAGEMENT OF COMPLEX RENAL CYSTS - A SERIES OF 32 CASES

Purpose: The differentiation between benign cysts of the kidney and th ose that require surgical exploration remains difficult. The accuracy of radiological techniques (ultrasound, computerized tomography [CT], angiography, magnetic resonance imaging, cyst puncture and intraoperat ive pathological examination) is analyzed. Materials and Methods: Surg ical exploration was performed in 30 patients with 32 asymptomatic ren al cysts, and the pathological specimens were-compared retrospectively to the radiological findings, The classification of Bosniak was used to categorize the ultrasound, and CT findings. Results: Of our complex renal cysts 41% proved to be malignant. Our results suggest that the radiological techniques are not well suited for characterization of th ese cysts. None of the Bosniak types was sufficiently predictive of th e lesion. Only a Bosniak score of 4 (the sum of ultrasound and CT Bosn iak types) was not associated with renal cell carcinoma, According to the radiological findings, 1 patient was under treated (recurrent rena l cell carcinoma) and 4 were over treated (radical nephrectomy for ben ign lesions). Conclusions: A practical therapeutic strategy is describ ed in which radical nephrectomy is performed when malignant lesions ar e detected either by preoperative or intraoperative techniques. Conser vative surgery is indicated for benign cysts according to the clinical status and risks of nephron sparing surgery.