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Detection of urinary cysts and renal carcinoma by biochemical analysis during laparoscopic decortication for renal cysts

Simple renal cysts are the most common renal masses in Urology. In general, making a diagnosis of a simple renal cyst is not difficult. However, some patients with calyceal diverticulum or hydronephrosis are misdiagnosed with simple renal cysts. Our study aimed to differentiate the simple cysts from other abnormalities by biochemical analysis of the cystic fluid during the laparoscopic procedure. A retrospective multi-institutional review of 57 patients undergoing laparoscopic decortication for renal cysts between 2013 and 2015 was performed. The cystic fluid was analyzed biochemically during the operation for detecting whether the cysts communicate with renal pelvis. The biochemical results of cystic fluid and serum were compared and statistical significance between two groups was determined by Student’s t-test. Biochemical analysis of cystic fluid showed 52 patients had simple cyst fluid, and pathological results confirmed as cyst wall. Four cases were considered as urinary fluid with high creatinine levels, among which, one was duplex kidney, two were calyceal diverticulum, and the other one was hydrocalycosis. Operation procedures were changed immediately for these 4 cases. The remaining one case had abnormal biochemical components with very low levels of potassium, sodium, calcium, and glucose and diagnosed as renal cell carcinoma by pathology. Thus, laparoscopic radical nephrectomy was applied afterwards. Therefore, biochemical analysis of cystic fluid during laparoscopic procedures can effectively differentiate simple cysts from urinary cysts and complications such as urinary leakage can be avoided. It can also provide a clue to detect cystic renal cell carcinoma.