Laparoscopic cyst decortication in autosomal dominant polycystic kidney disease: Impact on pain, hypertension, and renal function

David I. Lee, Cassio R. Andreoni, Jamil Rehman, Jaime Landman, Maged Ragab, Yan Yan, Cathy Chen, Alan W Shindel, William Middleton, Arieh Shalhav, Elspeth M. McDougall, Ralph V. Clayman

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23 Scopus citations

Abstract

Background and Purpose: In patients with autosomal dominant polycystic kidney disease (ADPKD), laparoscopic cyst decortication (LCD) has been proposed as a means to relieve chronic cyst-related pain. We present our 7-year experience with LCD for ADPKD with regard to pain relief, hypertension, and renal function. Patients and Methods: Between August 1994 and February 2001, 29 ADPKD patients with chronic pain (N = 29), hypertension (N = 21), and renal insufficiency (N = 10) underwent 35 LCD procedures. Every detectable cyst within 2 mm of the renal surface was treated. Pain relief was assessed using a pain analog scale; relative pain relief (RPR) equaled (preoperative pain score) - (postoperative pain score)/(preoperative pain score). Hypertension was evaluated using the antihypertensive therapeutic index (ATI): [(dose of blood pressure medication 1/max dose 1) + (dose med 2/max dose 2) + etc.] × 10. Renal function was assessed using the Cockcroft and Gault formula for creatinine clearance. Results: The mean operating room time was 4.9 hours (range 2.6-6.6 hours) with no conversions to open surgery. An average of 220 cysts (range 4-692) were treated per patient. The mean follow-up was 32.3 months (range 6-72 months). The RPR was 58%, 47%, and 63% at 12, 24, and 36 months, respectively. At 12, 24, and 36 months, 73%, 52%, and 81% of patients, respectively, noted >50% improvement in their pain compared with the preoperative situation. Five patients became normotensive, and patients improved their ATI by an average of 49% (range 11%-93%). However, six patients had worsening hypertension, with an ATI increase averaging 53% (range 11%-122%), and one patient who was not hypertensive preoperatively has since developed hypertension. The creatinine clearance changed +4%, +7%, and -2% at 12, 24, and 36 months, respectively. Only one patient had a >20% increase in creatinine clearance. The only patients with a >20% decrease in creatinine clearance were those who had a creatinine clearance <30 mg/dL preoperatively (average decrease 34% [range 20%-51%]). Conclusions: For ADPKD patients with debilitating pain, extensive LCD can provide durable relief. In the majority of patients with pain and hypertension, a marked improvement in blood pressure also occurs. Cyst decortication was not associated with worsening renal function; indeed, renal function remained largely unchanged over the 3-year follow-up period.

Original languageEnglish (US)
Pages (from-to)345-354
Number of pages10
JournalJournal of Endourology
Volume17
Issue number6
StatePublished - Aug 2003
Externally publishedYes

ASJC Scopus subject areas

  • Urology

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    Lee, D. I., Andreoni, C. R., Rehman, J., Landman, J., Ragab, M., Yan, Y., Chen, C., Shindel, A. W., Middleton, W., Shalhav, A., McDougall, E. M., & Clayman, R. V. (2003). Laparoscopic cyst decortication in autosomal dominant polycystic kidney disease: Impact on pain, hypertension, and renal function. Journal of Endourology, 17(6), 345-354.