Retroperitoneoscopic management of infected cysts in adult polycystic kidney disease

Conservative measures are the mainstay of therapy in adult polycystic kidne y disease (APKD). Pain, infection and obstructive uropathy are the major in dications for intervention. Chronic pain has been treated with narcotic ana lgesics, needle aspiration of dominant cysts, and open renal cyst decortica tion. Laparoscopic cyst decortication, by either transperitoneal or retrope ritoneal ac; cess, is a new emerging option with similar efficacy to open s urgery and less morbidity. Cyst infection in these patients responds poorly to commonly used antibiotics. Patients with refractory cyst infection may even require nephrectomy. Herein, we present 2 cases with APKD that were tr eated by retroperitoneoscopic decortication for painful and infected cysts. Both patients showed prompt and sustained improvement in symptoms, with mi nimal morbidity and short convalescence. This approach has not hitherto bee n described for infected cysts in APKD. The retroperitoneoscopic route shou ld be preferred in the presence of infected cysts so as to prevent intraper itoneal contamination.