Abstract：Objective:To establish the individualized surgical approaches for holmium laser and incision drainage with ureteroscope according to the features of kidney cystic lesions, and investigate the value and clinical application prospect of ureteroscope in the management of kidney cystic lesions. Methods:From Mar. 2008 to Dec. 2013, 70 cases of kidney cystic lesions were subjected to minimally invasive tunnel by using holmium laser and incision drainage. For 32 cases of peripheral renal cysts, the cysts were located in the front of and ventral to the renal pelvis which was pushed to the dorsal surface in 15 cases, and the surgical approach from skin to renal pelvis and then to cyst was chosen; and those behind and dorsal to the renal pelvis which was pushed to the ventral surface in 17 cases, and the surgical approach from skin to cyst and then to renal pelvis was chosen. For 38 cases of parapelvic cysts, there were 18 cases of cysts located in the upper pole of the kidney, and the surgical approach from urethra to renal pelvis and then to cyst with ureteroscope was chosen; there were 20 cases of cysts located in the middle and the bottom of the kidney, and the surgical approach from urethra to renal pelvis and then to cyst with flexible ureteroscope was chosen. The cystic diameters were from 4.5 to 7.0 cm with the average of 5.75 cm. Forty-nine cases complained of pain symptoms on the loin and back. Twenty-one cases having no symptoms were presented in physical examination. All the cases were diagnosed as renal cysts undergoing B ultrasound, IUV, CT and MRI preoperatively. Double J stent was placed post-operation. Results:All the operations were successfully carried out. The operative time was from 30 to 90 min with the average of 60 min. The intraoperative blood loss was 5 to 100 mL with the average of 52.5 mL. There were no conversions to open surgery, vascular injury and accidental injury. Urethral catheter, nephrostomy tube and double J tube were pulled out 2 days, 5 to 7 days and 2 months after the operation respectively. The nephrostomy healed after 24 h and had no urinary fistula and extravasation. The hospital stay was 5 to 9 days with the average of 7 days. During the follow-up period of 3 to 24 months, B ultrasound or CT examination revealed that 68 cases had no recurrence and only two patients had a recurrence with the cystic diameter less than 2.0 cm. Ureteroscopy confirmed cystic incision drainage closed again. Conclusions:The individualized surgical approach according to the features of kidney cystic lesions by using holmium laser and incision drainage with ureteroscope is a new minimally invasive method with safety, efficiency, less injury, and low recurrence. It's the expand of ureteroscopy and has more advantages over other treatments.
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