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

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.] x 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.

• Authors: David I Lee, Cassio R Andreoni, Jamil Rehman, Jaime Landman, Maged Ragab, Yan Yan, Cathy Chen, Alan Shindel, William Middleton, Arieh Shalhav, Elspeth M McDougall, Ralph V Clayman
• Journal: Journal of endourology (J Endourol) Vol. 17 Issue 6 Pg. 345-54 (Aug 2003) ISSN: 0892-7790 [Print] United States
• PMID: 12965058 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Analgesics
• Creatinine

Topics

• Adult
• Aged
• Analgesics (therapeutic use)
• Awards and Prizes
• Blood Loss, Surgical
• Creatinine (metabolism)
• Female
• Follow-Up Studies
• Humans
• Hypertension (etiology, surgery)
• Kidney (diagnostic imaging)
• Laparoscopy (methods)
• Length of Stay
• Male
• Middle Aged
• Outcome and Process Assessment, Health Care
• Pain (drug therapy, etiology, surgery)
• Polycystic Kidney, Autosomal Dominant (complications, metabolism, surgery)
• Quality of Life
• Radionuclide Imaging
• Renal Insufficiency (etiology, surgery)
• Treatment Outcome
• Ultrasonography