Urology Clinic RBH

The Urology clinic in RBH is the centre of excellence in Bahrain for the following treatments -

Laser surgery for prostate diseases.
Laser surgery for kidney stones.
Urodynamic study and incontinence treatment.
Laparoscopic urology.
Microscopic varicocele surgery.
Erectile dysfunction and Penile Prosthesis implantation.
Infertility Treatment.
Female urology and Sexual health.
No Needle No scalpel Vasectomy.
Cancer Screening and treatment.
Plastibell Circumcision
.

SIMPLE RENAL CYST (KIDNEY CYST)

My father was having loin pain and was diagnosed by family doctor as simple renal cyst. What is a simple renal cyst?


A renal cyst (kidney cyst) is a small bubble filled with fluid and located in the kidneys. Most renal cysts are benign, and people can live out their entire lives without any knowledge of a cyst. In cases were the enlarging cyst causing pain or discomfort the doctor may recommend surgery to remove the renal cyst.




How do you diagnose renal cysts?

Usually renal cysts are identified on ultrasound, CT or MRI and are present in 50 % of normal individuals. In the case of a simple cyst, the cyst contains clear to yellowish fluid, sometimes mixed with blood. On the other side there are complex renal cysts which have irregularities such as calcification, meaning that there is solid material inside the cyst, or they have internal septations. A complex renal cyst is a cause for concern because it can be associated with the development of kidney cancer.

                                                     Ultra sound Scan of a renal cyst.


                                                         CT Scan of a renal cyst.

What is a polycystic kidney?


Some people have many renal cysts at birth called congenital polycystic kidney disease. This is usually a genetic condition in which numerous cysts develop in the kidneys; causing damage to the kidneys. The poly cystic kidney disease can also develop during the adulthood and known as adult polycystic kidney disease.

Are there any other causes of renal cyst?

In rare circumstances certain worms like Tapeworms can also cause renal cysts. These Cysts caused by tapeworms can also appear in other organs of the body, and they are usually associated with a decline in organ function.

How do they usually present ?

Kidney cysts can present as

• As an accidental finding.

• Flank or back pain.

• Abdominal pain or discomfort.

• Blood in urine.


How do you treat this condition?

If the cyst is enlarging in size or suspicious of cancer, it can be removed surgically. The treatment usually provided in RBH are

• Simple Ultrasound guided cyst aspiration and injection of sclerosant.


• Laparoscopic renal cyst removal-key hole surgery to removal the renal cyst.


I was diagnosed as renal cyst Bosniac class II F .what protocol do you follow in complex cysts?

Bosniak Classification of Renal Cysts is as follows:


Class I lesions are simple, benign cysts. The characteristics of a simple cyst include a well-defined and homogeneous mass with a thin, imperceptible wall. These lesions do not enhance and have the attenuation value of water density. If these criteria are met, no further workup is necessary.

Class II lesions are minimally complicated cysts with features that cause concern. Internal septations that are smooth, thin and do not have thickened elements may be considered benign. A thin, peripheral rim of calcification in the cyst wall or septa may also be considered benign. These lesions do not show enhancement, have smooth, sharp margins, and are homogeneous. No further workup is necessary.

Class IIF lesions are more suspicious cysts. These lesions are minimally complicated cysts but may be hyperdense, may contain more calcium in the wall, or may have thicker internal septations. Follow up scanning is recommended.

Class III lesions are more complicated cystic structures that often show irregular and thickened septa, wall thickening, solid non-enhancing mural nodules, or irregular calcifications. This category also includes multiloculated cysts. These lesions require surgical exploration.

Class IV lesions show non-uniform wall thickening, have irregular margins, and/or contain solid components that enhance on CT. These lesions are clearly malignant and total nephrectomy is warranted.

The decision to undergo treatment depends on the risk of the lesion.So we follow the given below protocol.
Class I: Simple cysts, nearly 100% benign -renal cyst aspiration or Laparoscopic deroofing.

Class II: Minimally complicated cyst, nearly 100% benign- renal cysyt aspiration or Laparoscopic deroofing.


Class IIF: Minimally complicated cyst with suspicious features, follow up scan recommended, most likely benign .If opted for surgical treatment we provide Laparoscopic removal of the lesion.
Class III: Moderately complicated or multiloculated cyst, 50% malignant, surgery recommended .We provide laparoscopic removal of the lesion.

Class IV: Cleary malignant lesion, we provide laparoscopic partial removal of the kidney or complete removal of the kidney.

Percutaneous biopsy of suspicious kidney lesions should never be done if you are suspecting malignancy because it can cause tumour spillage,seeding or tumour spread.