Hydatid Cyst of the kidney and Ureter: A Review and Update of the Literature

Abstract

Echinococcal (Hydatid) cyst of the kidney is a very uncommon disease which is sporadically reported in Echinococcal endemic areas of the world as well it tends to be reported in non-endemic areas in view of global travel on extremely rare occasions. Hydatid cyst of the kidney could manifest with non-specific symptoms including: loin/flank pain or discomfort; abdominal pain; a mass within the loin or abdomen; hydatiduria; abdominal distension; weight loss; other non-specific symptoms. A history of residence in or having travelled from an echinococcal endemic area and having been in contact with animals including dogs does play an important role in alerting the clinician regarding the possibility of Echinococcal disease is useful. The general and systematic examinations could be normal but tenderness within the loin and tenderness in the upper abdomen could be found which may or may not be associated with a palpable mass within the loin or upper abdomen. The results of routine haematology and biochemistry blood tests could be normal except at times there could be eosinophilia. Urinalysis could show hydatiduria. A positive Casoni intradermal test results or a positive Echinococcal serology test would tend to alert clinicians about Echinococcal disease. Radiology imaging of the abdomen and renal tract including ultrasound scan, computed tomography scan and magnetic resonance scan, of the abdomen would show the cyst (most commonly) or cysts, (occasionally) within the kidney as well the size of the cyst and the amount of normal looking renal parenchyma and presence of daughter cysts could be demonstrated. Furthermore, if there is hydronephrosis or hydroureter the radiology images would reveal it. Treatment of hydatid cyst of the kidney does entail treatment with a combination of: Cycles of anti-scolicidal medications of which albendazole is the commonest used medicament and. Surgical treatment could include: Laparoscopic Drainage of the hydatid cyst and peri-cystectomy. Laparoscopic partial nephrectomy. Laparoscopic nephrectomy excising the entire kidney on rare occasions. Laparoscopic nephroureterectomy when the ureter is also involved by hydatid cyst. Open surgical drainage of the hydatid cyst and peri-cystectomy. Open drainage of the hydatid cyst and partial nephrectomy. Open drainage of the hydatid cyst and full nephrectomy. Open drainage of the hydatid cyst and nephroureterectomy if there is an associated hydatid cyst of the ureter. If there is an associated hydatid cyst elsewhere for example in the liver that cyst would also be carefully excised. Utilization of antiscolicidal medicaments alone without surgery had yielded poor results and recurrence of cysts with the exception of one reported case in which utilization of albendazole alone was associated with a good outcome. Aspiration alone of the hydatid cyst has not emanated in good results therefore it is not an option of treatment generally used. With regard to outcome a combination of treatment with albendazole and complete excision of the hydatid cyst of the kidney without spillage from the cyst does result in good outcome and no recurrence of the cyst. Occasional recurrence of the hydatid cyst of the kidney has been reported which could perhaps have been due to incomplete excision of the cyst or spillage of the cyst content plus or minus not having taken enough anti-scolicidal agents although some patients had been successfully treated with complete excision of the hydatid cyst alone without antiscolicidal medicament.