Presented Wednesday, 05 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Hydatid disease is still endemic in our country. The kidney is a relatively rare site, representing 2 to 4%. Laboratory tests may suggest the diagnosis, which is confirmed by radiology. Renal hydatid cyst raises therapeutic problems making sometimes conservative surgery difficult. Our objective is to find the best treatment adapted of this pathology.

Methods: We reviewed clinical records of 43 cases of hydatid cyst of the kidney diagnosed between 1982 and 2006. There were 31 men and 12 women with a mean age of 43 years. Clinical features were dominated by pain (87.7%), palpable lumbar mass (61%), hydaturia (15%) and haematuria (11%). Intravenous urography (21 patients) showed a mass syndrome (66.6%) with calcifications (63%). Ultrasonography allowed diagnosis suspicion in 74.7% and classification of the hydatid cyst (type I: 18 cases, II: 6 cases, III: 8 cases, IV: 9 cases, V: 2 cases). In fact, the most difficult problem was for the type IV which could be confused with renal tumor. Computed tomography was performed in 9 cases. Hydatid serology was positive in 75%. Ten patients had extra renal localizations: liver (7), spleen (4). No pulmonary localization was observed.

Results: All our patients were operated. They underwent resection of the prominent dome (33 cases), pericytectomy (6 cases) and nephrectomy (4 cases). A urinary fistula was found in 7 cases; it was treated by simple closure with placement of a nephrostomy catheter. The postoperative course was marked by a persistent fistula (2 cases) and suppuration of the residual cavity of the cyst (2 cases) which were treated by ultrasound-guided aspiration- drainage. Finally, we observed one case of digestive fistula which was managed surgically. All of these complications were treated successfully. The follow-up was uneventful with a mean of 7 years.

Conclusions: Renal localization of hydatid disease is a benign affection in spite of its apparent morbidity, which could be raised after surgical processing. However, the best processing remains preventive.

Authors: Bouacida M, Ketata H, Benabdallah I, Jallouli H, Kchaou S, Fakhfakh H, Bahloul A, Mhiri MN

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