Autosomal Dominant Polycystic Kidney Disease

In patients with autosomal dominant polycystic kidney disease, flank and/or abdominal pain are the most common presenting symptom and have been noted in 60% of autosomal dominant polycystic kidney disease patients (31). These symptoms have been attributed to massive enlargement of the kidneys due to growth of a multitude of renal cysts with stretching of the renal capsule, traction on the renal pedicle, and/or obstruction of the collecting system. These cysts have also been associated with the development of hypertension. In the largest series of autosomal dominant polycystic kidney disease cases to date, Dunn et al. reported on 15 patients who underwent a total of 21 laparo-scopic ablation procedures (23). Advocating aggressive and thorough identification and treatment of as many cysts at the time of surgery, an average of 204 cysts were treated per procedure with a range of 11 to 635 cysts. Eighty-seven percent of patients reported symptomatic relief immediately following surgery and with a mean follow-up of 2.2 Cumulative results of laparoscopic years; 73% reported, on average, a 62% improvement in preoperative pain.

ablation in patients with autosomal As shown in Table 6, cumulative results of laparoscopic ablation in patients with dominant polycystic kidney disease autosomal dominant polycystic kidney disease suggest an initial symptomatic success suggest an initial symptomatic success rate of 75% to 100% and 57% to 73% at two years follow-up (21-23,27,32,33). rate of 75% to 100% and 57% to 73% Hypertension remained unchanged or improved in 67% and renal function at two years follow-up. remained stable in 94% of patients in the series reported by Dunn et al. (23). The authors concluded that with extensive, bilateral laparoscopic renal cyst ablation in patients with autosomal dominant polycystic kidney disease, improvement in both pain and hypertension could be realized without compromising renal function. Furthermore, their early results favored bilateral versus unilateral cyst ablation. Extensive cyst ablation, however, is time consuming with an average operative time of 330 minutes.

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