Laparoscopic cyst marsupialization in patients with autosomal dominant polycystic kidney disease

Purpose: Autosomal dominant polycystic kidney disease is characterized by p rogressively enlarging renal cysts associated with hypertension, renal fail ure, pain, hematuria and infection. We explored the role of laparoscopic cy st marsupialization for managing cyst related problems. Materials and Methods: In 4 male and 11 female adults with autosomal domina nt polycystic kidney disease who had preserved renal function laparoscopic cyst marsupialization was done for pain unilaterally and bilaterally in 9 a nd 6, respectively. An average of 204 cysts per kidney (range 11 to 635) we re decorticated or drained. Results: Average operative time was 5.5 hours. Patients were discharged fro m the hospital after an average of 3.2 days. At a mean followup of 2.2 year s (range 0.5 to 5) pain was decreased an average of 62% (range 30% to 90%) in 11 cases (73%). One patient had no improvement and 1 had subsequent wors ening of pain postoperatively. Two patients with initial improvement had pa in recurrence 4 and 36 months postoperatively, respectively. Hypertension r esolved in 1 patient (7%), improved in 20% and did not change in 40%. In 33 % of the cases hypertension worsened, requiring additional antihypertensive medication. Renal function remained stable in 13 patients (87%), improved in 1 (6.5%) and worsened in 1 (6.5%). Overall patients who underwent a bila teral procedure had better long-term pain relief and more improvement in hy pertension. Conclusions: Laparoscopic cyst marsupialization may effectively decrease cy st associated pain. In some cases hypertension may be improved. Renal funct ion remained stable in all except 1 patient. At a mean followup of 2.2 year s the benefits of aggressive laparoscopic cyst decortication appear to be r elatively long lasting when bilateral decortication is indicated. The benef its of unilateral cyst decortication are less predictable and of shorter du ration.