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kidney cysts
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kidney cysts

I have a kidney cyst on my right kidney. it was found during a routine MRI for impending back surgery. It is benign but is causing me some pain in my back especially when I run. I generally run 5 miles per day. The urologists said that normally he would leave the cyst unattended but there is concern because of its size. it is 11.8 centimeters.  I am a very small person  (approximately 5 feet 2inces and a 105 pounds). I am very small boned and the cyst on an unltrasound is massive. They talk about unroofing the cyst. What is that exactly and what is involved with the surgery? Is it an out patient procedure. Thank you. cyst sister
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Hello - thanks for asking your question.

As I am not a surgeon, I have no experience in unroofing kidney cysts.  However, there are several websites that explain the procedure in detail.  Here is a description from the Cornell University Department on Urology:

"Unroofing of Renal Cysts and Renal Biopsy

Indications - Cysts can form in the kidney for many reasons and mostly are non-cancerous, benign and require no further intervention. However, in some instances a cyst may enlarge to the point that it causes pain, obstructs the kidney or leads to high blood pressure. Cysts may become infected or bleed. Sometimes a cyst, which at one time appeared benign, may change its shape or features to the extent that malignancy is suspected. For any of the above reasons cyst unroofing and subsequent biopsy may be required. In addition certain renal diseases require a biopsy for diagnosis.
Laparoscopy has provided an ideal way to manage these problems. No large incisions are required, direct visualization of the cyst and/or kidney is provided and tissue for the pathologist is obtained for more detailed evaluation. In addition an ultrasound probe may be placed through one of the ports to examine the remainder of the kidney with the highest resolution possible.

Procedure - The patient must undergo general anesthesia for this procedure. Two to three small cylindrical tubes called trocars are placed into the abdominal cavity. The trocars allow entry of a video-telescope, called a laparoscope, to view the entire abdominal cavity and kidney. Accessory small trocars allow the introduction of fine instruments necessary to perform surgery. With all the trocars and instruments in place the surface of the cyst is completely exposed and cyst fluid is drained. The cyst is then cut out and the base of the cyst biopsied. The cyst fluid and biopsy are sent to the pathologist for analysis. When only a kidney biopsy is required a portion of the kidney is exposed and a biopsy is taken. An advantage of this technique is that an ultrasound probe may be placed through the trocar directly onto the kidney to help guide where the biopsy should be performed and to image the kidney.

Result -Investigators have demonstrated success rates in greater than 95% in patients undergoing cyst unroofing with low complication rates. Operative time averages 90 minutes. Hospital stay is less then 48 hours in most cases. Pain medication requirement is minimal and return to work is often within 2 to 3 weeks. Other options to treat this problem include an open incision. In cases requiring an open procedure pain medication, hospital stay and time to return to work are all longer. Another method to treat renal cysts and/or renal biopsy is placing a needle through the skin into the cyst and/or kidney using the help of x-rays. In theory this procedure is less invasive than laparoscopy however this technique does not allow direct visualization of the kidney or cyst, does not provide a large sampling of tissue, does not allow for high resolution ultrasound guidance and has a relatively high incidence of recurrence when performed for cyst management."
http://www.cornellurology.com/uro/cornell/mas/procedures/renal_biopsy.shtml

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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