Tetracycline Hydrochloride Sclerotherapy: Renal, Hepatic, Ovarian, and Perivesical cysts

PURPOSE: To assess the efficacy and resulting complications of tetracycline sclerotherapy in renal, hepatic, ovarian, and perivesical cysts. MATERIALS AND METHODS: We retrospectively reviewed 23 cases of benign cysts (16 renal, 4 hepatic, 2 ovarian, and 1 perivesical) in 22 patients in whom the condition was diagnosed or confirmed by either ultrasound, CT, or cytology, and who underwent percutaneous tetracycline sclerotherapy. Using a 21-gauge Chiba needle, the target cyst was punctured under ultrasound guidance. Prior to the injection of 1500 mg of tetracycline diluted in 5 ml of normal saline, almost all the cystic content was aspirated, and at the end of the procedure the tetra-cycline was left in the cyst. During a period of between 3 and 22 months, 18 of the 23 cases were followed up. RESULT: In six of the 18 cases followed up, the cysts either decreased in size by 10%, or collapsed completely. In seven cases a collapse of over 50% was noted, and in the remaining five the cyst recurred. In one of these, complete collapse occurred after retreatment at ten months, and the patient with a perivesical cyst underwent surgery six months after recurrence. Thus, treatment was effective (a collapse of at least 50%) in 13 of 18 cases (72.2%). This total of 13 comprised ten of 12 renal cysts (83.3%), two of two ovarian (100%), and one of three hepatic (33.3%). Percutaneous therapy was unsuccessful in five cases (two hepatic cysts, one renal, one para-pelvic and one perivesical). Complications occurring during the procedure or follow-up period included discomfort or mild pain, vomiting, and transient fever, though these subsided within 24 hours. In one patient with severe pain, this subsided after four days. CONCLUSION: As single-shot injection of tetracycline provides safe and effective treatment for renal and ovarian cysts, but for hepatic cysts is unsuccessful.

Acetic Acid Sclerotheraphy of Renal Cysts

PURPOSE: Sclerotherapy for renal cysts was performed, using 50% acetic acid as new sclerosing agent. Wereport the methods and results of this procedure. MATERIALS AND METHODS: Fifteen patients underwent sclerotherapyfor renal cyst, using 50% acetic acid. Because four patients were lost to follow-up, only 11 of the 15 wereincluded in this study. The renal cysts, including one infected case, were diagnosed by ultrasonograpy (n=10) ormagnetic resonance imaging (n=1). The patient group consisted of four men and seven women (mean age, 59 years;range, 23-77). At first, the cyst was completely aspirated, and 25 volume% of aspirated volume was replaced with50% sterile acetic acid through the drainage catheter. During the following 20 minutes, the patient changedposition, and the acetic acid was then removed from the cyst. Finally, the drainage catheter was removed, aftercleaning the cyst with saline. After treatment of infection by antibiotics and catheter drainage for 7 days,sclerotherapy in the infected case followed the same procedure. In order to observe changes in the size of renalcysts and recurrence, all patients were followed up by ultrasound between 2 and 8 months. We defined response totherapy as follows: complete regression as under 5 volume%, partial regression as 5-50 volume% and no response asmore than 50 volume% of initial cyst volume. RESULTS: No clinically significant complication occured during theprocedures or follow-up periods. All cysts regressed completely during follow-up of 8 months. Complete regressionoccurred as follows : two cysts at 2 months, seven cysts at 4 months, two cysts at 6 months. Two cysts showedresidues at the last follow-up, at 4 and 6 months, respectiivery. The volume of residual cysts decreased to under5 volume% of initial volume, however. Completely regressed cysts did not recurr during follow-up. CONCLUSION: Acetic acid sclerotherapy for renal cysts showed good results, regardless of the dilntion of sclersoing agent withresidual cyst fluid, and no significant complications. the procedure, therefore, appears to provide effectivetherapy for renal cysts.

An Experimental Study for Efficacy of Acetic Acid as a Sclerosing Agent

PURPOSE: To evaluate the efficacy of acetic acid as a sclerosing agent by observation of histologic change in urinary bladder epithelium after the instillation of acetic acid. MATERIALS AND METHODS: Urinary bladder of the rabbit was catheterized with a Foley catheter, and acetic acid of 10%, 20%, 30%, 40% and 50% concentration was instilled for 5 minutes. After evacuation of the acid, the bladder was irrigated three times with normal saline. After two days, gross and histologic examinations of the bladder were performed. RESULTS: A bladder into which10% acetic acid had been instilled revealed a nearly normal epithelium without denudation. In two cases, 20% acetic acid was instilled; one revealed partial denudation of the epithelium and the other revealed complete denudation. Mild to moderate interstitial edema and vascular congestion of the bladder wall were evident in all cases in which acid at a concentration of 30% or more had been instilled. In all cases in which the concentration of acid was greater than 30%, the epithelium was completely denuded. CONCLUSION: An acetic acid concentration of 40% or more is sufficient to completely destroy the epithelium of rabbit urinary bladder, and may be effective as a new sclerosing agent in cases of renal or hepatic cyst.