Large Renal Cyst: Puncture and Drainage Help Patient Overcome a Critical Situation
Wang, a patient, is an intelligent, kind, and warm-hearted young man. In early June of this year, he married his wife. Just five days after the wedding, Wang developed a persistent high fever; even after receiving treatment at a local clinic, he continued to experience intermittent bouts of fever. He subsequently sought further care at a county hospital, where examinations revealed that a previously diagnosed renal cyst had grown from 4 cm to 9 cm. He later visited a city-level hospital for follow-up, where he received symptomatic treatment—such as fever-reducing medication—though the renal cyst itself remained unaddressed.
Following his discharge, Wang began to exhibit emotional instability, which gradually escalated into manic, agitated behavior. Hoping to see her husband recover and restore the happiness they once shared, his wife took him to Xi’an to seek a definitive diagnosis and further treatment.
At the first hospital he visited, he was prescribed fever-reducing medication. At the second, clinicians suspected a psychological disorder—manifesting as mania—and recommended that he seek care at a specialized psychiatric facility. Upon arriving at the psychiatric hospital, a follow-up ultrasound of the urinary system revealed that his right renal cyst had grown further, reaching 21 cm, while his psychological distress continued to worsen.
On July 23, as his high fever persisted and his abdominal pain and distension intensified, the psychiatric hospital—suspecting the renal cyst as the underlying cause—urgently transferred him to the Emergency Department of Xi’an Gaoxin Hospital. Following an initial assessment, the Emergency Department requested a consultation with the on-duty physician from the First Urology Ward. After a detailed review of his medical history and a physical examination, Wang was admitted to the hospital.
Following his admission, Wang’s behavior fluctuated between manic agitation and profound apathy. His family and wife were left feeling helpless; his wife, struggling to come to terms with such a sudden and drastic change in her new husband, spent her days in tears. The medical staff in the First Urology Ward worked to comfort the family while simultaneously providing emotional support to the patient. Following an initial physical examination and diagnostic tests, the patient, surnamed Wang, was diagnosed with a horseshoe kidney, accompanied by a massive cystic lesion within the renal parenchyma (measuring approximately 17.4 × 12.2 × 21 cm). Additional findings included dilation and hydronephrosis of the right renal pelvis, partial duplication of the upper ureter, and dilation of the left renal pelvis (with the left ureter not clearly visualized).
As the diagnostic reports provided further clarity, the team led by Dr. Zhang Liuyong from the First Urology Department conducted a thorough analysis. Given the rapid enlargement of the horseshoe kidney and the associated renal cyst—compounded by systemic symptoms such as fever—the team suspected an intracystic infection (pyocyst). Both laparoscopic and open surgical interventions posed extremely high risks. Furthermore, abdominal CT scans suggested that the cyst was enveloped by the mesentery and intestinal loops, creating a significant risk of vascular injury and hemorrhage during any percutaneous puncture.
With both open surgery and needle aspiration presenting substantial risks—while the physical and psychological toll on the newlyweds continued to mount—Dr. Zhang Liuyong’s team concluded that surgical intervention was unavoidable, though the specific approach required careful deliberation.
Traditional open surgery carries higher risks related to anesthesia, significant surgical trauma, a greater likelihood of complications, longer recovery times, and generally higher medical costs. In contrast, percutaneous renal cyst aspiration is minimally invasive, convenient, less painful, effective, and more cost-effective; among image-guided techniques, ultrasound guidance is the most straightforward, accessible, and rapid method.
Following a comprehensive assessment in consultation with Dr. Huang Xiaoxin, Director of the Ultrasound Department, it was decided to perform a percutaneous aspiration and drainage of the cyst in the horseshoe kidney. After thorough discussions with the patient and his family, the procedure was scheduled for July 27.
On July 27, with the assistance of Dr. Huang Xiaofeng (Director of the Ultrasound Department) and Dr. Zhang Yinxin, Dr. Zhang Liuyong and his team performed the percutaneous aspiration and drainage of the renal cyst. During the procedure, coffee-colored purulent fluid was drained from the cyst; over the 24 hours following the operation, a total of 2,100 ml of this coffee-colored purulent fluid was evacuated. Under the meticulous care of the nursing team led by Head Nurse Wang Yantao, the patient’s abdominal distension significantly subsided post-operatively, his body temperature gradually returned to normal, and symptoms of systemic infection were effectively brought under control. By the fifth day after the procedure, the patient’s psychological state had stabilized—his agitation and restlessness had vanished—and all clinical test results had returned to the normal range.
After nearly two months, the patient has finally regained his health, returning to a life that may appear simple and quiet, yet is, in reality, filled with happiness. It is certain that, having weathered this major challenge, he and his partner will emerge with a stronger, more resilient bond, and their future life will be vibrant and full of warmth.
Renal cyst puncture is a highly practical, minimally invasive (non-open) surgical treatment. It carries low risk, is cost-effective, is well-tolerated by patients, and allows for a rapid post-operative recovery—typically without interfering with one’s work or daily life. It serves as an effective method for treating renal cysts.
Primary indications include:
Simple renal cysts: Not all simple renal cysts require puncture treatment. However, intervention—specifically puncture and sclerotherapy—is indicated if any of the following conditions are present:
The presence of symptoms or clinical signs, such as flank pain, hematuria, or a palpable mass in the lumbar region;
Hydronephrosis (kidney swelling) caused by the cyst exerting pressure;
A cyst that is excessively large, exceeding 4 cm in diameter.
Parapelvic cysts: These cysts are prone to compressing the renal pelvis or calyces, leading to hydronephrosis; therefore, treatment should not be delayed until the cyst reaches 4 cm in size.
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