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Ebook Oxford handbook of urology (3/E): Part 2

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Part 2 book “Oxford handbook of urology” has contents: Miscellaneous urological disease of the kidney, stone disease, upper tract obstruction, loin pain, hydronephrosis, trauma to the urinary tract and other urological emergencies, infertility, sexual health, neuropathic bladder, urological problems in pregnancy, paediatric urology, and other contents. | Chapter 8 Miscellaneous urological diseases of the kidney Simple and complex renal cysts 396 Calyceal diverticulum 399 Medullary sponge kidney (MSK) 400 Acquired renal cystic disease (ARCD) 402 Autosomal dominant polycystic kidney disease (ADPKD) 404 Vesicoureteric reflux in adults 408 Pelviureteric junction obstruction in adults 412 Anomalies of renal fusion and ascent: horseshoe kidney, ectopic kidney 416 Anomalies of renal number and rotation: renal agenesis and malrotation 420 Upper urinary tract duplication 422 395 396 CHAPTER 8 Miscellaneous urological diseases Simple and complex renal cysts Simple renal cysts: do not communicate with any part of the nephron or the renal pelvis. They are mainly confined to the renal cortex, are filled with clear fluid, and contain a membrane composed of a single layer of flattened or cuboidal epithelium. They can be single or multiple, ranging from a few millimetres to several centimetres in diameter. They can be unilateral or bilateral and often affect the lower pole of the kidney. Parapelvic cysts: describe simple parenchymal cysts located adjacent to the renal pelvis or hilum. Prevalence Increases with age, the precise prevalence depending on the method of diagnosis. On CT, 20% of adults have renal cysts by age 40y and 33% by the age of 60.1 At post-mortem, 50% of subjects aged >50y have simple cysts. Cysts do not usually increase in size with age, but may increase in number. Males and females are affected equally. Aetiology Both congenital and acquired causes have been suggested. Chronic dialysis is associated with the formation of new simple cysts. Presentation Simple cysts are most commonly diagnosed as an incidental finding following a renal ultrasound scan (USS) or CT performed for other purposes. The majority are asymptomatic; however, very large cysts may present as an abdominal mass or cause dull flank or back pain. Acute severe loin pain may follow bleeding into a cyst (causing sudden distension of the wall). .