95% ethanol rinses combined with lauromacrogol injection versus lauromacrogol injection alone in the ultrasound-guided percutaneous sclerotherapy for simple renal cysts in elderly patients：Which is safer and more effective?

95% ethanol rinses combined with lauromacrogol injection versus lauromacrogol injection alone in the ultrasound-guided percutaneous sclerotherapy for simple renal cysts in elderly patients：Which is safer and more effective? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 95% ethanol rinses combined with lauromacrogol injection versus lauromacrogol injection alone in the ultrasound-guided percutaneous sclerotherapy for simple renal cysts in elderly patients：Which is safer and more effective? Kan Gao, Feiliang Wang, Lengnan Xu, Weide Dai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5280608/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background To compare the effcacy and safety of 95% ethanol rinses combined lauromacrogol injection and lauromacrogol injection alone in scleratherapy of renal cyst. Methods We retrospectively analysed 97 symptomatic Bosniak type I renal cysts between 2019 and 2023 underwent by US-guided percutaneous sclerotherapy. 23 cases were treated by lauromacrogol injection alone, and 74 were treated by 95% ethanol rinses combined lauromacrogol injection. All cysts were followed up at 1, 6 and 12 months after the procedure. Success was defined as cured or effective: >90% reduction or 50–90% reduction in cyst size, respectively. Failure was defined as < 50% reduction in cyst size. Intraoperative pain, fever, drowsy, and minor hematuria defined as complication were assessed within 3 days after the operation. Results The volume of renal cysts tended to shrink during follow-up. The total resolution rate and the cure rate was 96.9% (94/97) and 90.7% (88/97), respectively at 12 months. No significant differences in the reduction of volume reduction rate, resolution rate and cure rate were observed between the groups during follow-up (P > .05). The complication rates for ethanol combined group 58.1% (43/74) were higher than those for lauromacrogol alone group 17.4% (4/23) (P < .05). Ethanol was found to be significantly painful and prone to cause fever, even used to rinse the lumen of simple renal cysts before lauromacrogol injection . Conclusion Success of percutaneous scleratherapy of renal cysts can be obtained in two groups. However, the safety was much higher in lauromacrogol injection alone. renal cyst 95% ethanol lauromacrogol scleratherapy ultrasound Figures Figure 1 Figure 2 Background Simple renal cysts are common benign diseases in elderly patients, and their prevalence is strongly associated with age [ 1 ] . Some large renal cysts (> 5 cm in diameter) induce flank/back pain, hematuria, hypertension and pelvicalyceal obstruction, depending on their specific location [ 2 ] . Ultrasound-guided sclerotherapy, a common minimally invasive treatment, has recently been confirmed to be a successful and safe procedure for treating symptomatic renal cysts, especially in the elderly population, who are at increased risk of anaesthesia [ 3 , 4 ] . Ethanol has been confirmed as the most commonly administered agent at various concentrations [ 5 , 6 ] . At high concentrations, ethanol can destroy epithelial cells in the cystic wall within minutes [ 7 ] , but the complications are more obvious, which includes mild or moderate pain during the operation and a mild and transient fever within several days after the procedure [ 8 ] . Lauromacrogol was first used as a local anaesthetic, was adopted as a painless sclerosant in many fields and has been reported to have a low incidence of allergic effects [ 9 , 10 ] . Rare literatures were reported about the comparison of 2 combined agents and 1 separate agent in one trial. In this study, we compared the efficacy and safety of the use of 95% ethanol rinses combined with lauromacrogol injection and lauromacrogol injection alone in ultrasound-guided percutaneous sclerotherapy for treating senile renal cysts. Methods Ninety-seven simple renal cysts between March 2019 and June 2023 were included in this retrospective study, treated with ultrasound-guided percutaneous sclerosant injection and followed up till 12 months. This study aim to compare the efficacy and safety of combination of 95% ethanol and lauromacrogol and lauromacrogol alone in percutaneous sclerotherapy of simple renal cysts in elderly individuals during 12 months period. Patients Patients were selected according to the following criteria: (1) symptomatic Bosniak type I and II renal cysts with a maximum diameter larger than 50 mm on ultrasound; (2) a history with presenting symptoms induced by renal cysts, such as pain, intracystic haemorrahge or infection, and hydronephrosis; (3) predominant cysts inducing flank/back pain from autosomal dominant polycystic kidney disease (ADPKD). The exclusion criteria were as follows: (1) allergy to alcohol and lauromacrogol; (2) pregnancy; (3) patients with serious cardiovascular or cerebrovascular diseases, severe mental disorders, and inability to tolerate the treatments; (4) recent anticoagulation treatment, severe coagulopathy, and bleeding tendencies; and (5) systemic symptoms of infection such as fever or the use of cephalosporins. Procedure Renal ultrasound examination focused on the sonographic features of the target cysts was performed, and the best puncture route was carefully evaluated before treatment. Ultrasound-guided sclerotherapy was subsequently carried out in an outpatient clinic. The patients were placed supine, in a lateral decubitus position, and under local anaesthesia with 3% lidocaine. A 20-gauge puncture needle was inserted into the cyst under ultrasound guidance and connected to a T-junction, connecting tube and 60-ml plastic syringe. Ten milliliters of fluid from the cyst was aspirated and used for the protein coagulation test. If the result was positive, the cyst was confirmed to have no communication with the pelvicaliceal system, and it was aspirated completely. After that, in the combined group, 95% ethanol in a volume equivalent to 20% of the cyst volume (to a maximum of 20 mL) was instilled, the lumen of the cyst was rinsed repeatedly, and the mixture was reaspirated. Afterwards, lauromacrogol (lauromacrogol injection, 10 mL:100 mg; Tianyu Pharmaceutical Co. Ltd., Shanxi, China) was injected and remained in the cysts. In the lauromacrogol group, only lauromacrogol was instilled and remained in the lumen of the cyst. The volume of lauromacrogol (liquid or foam) was equivalent to 30% of the cyst volume (to a maximum of 60 mL). The patients were asked to apply pressure over the puncture site for 20 minutes and leave the clinic without regional bleeding on ultrasound scanning. Follow-up The complications were evaluated within 3 days after sclerotherapy. The patients were followed up at 1 month, 6 months, and 12 months. The volume of the nodules was evaluated by ultrasound examination before treatment and at 1, 6 and 12 months of follow-up. The volume of each nodule and the volume reduction rate (VRR) were calculated via the following equations: \(\:\text{v}\text{o}\text{l}\text{u}\text{m}\text{e}\:=\:\frac{{\pi\:}\:\text{a}\text{b}\text{c}}{6}\) where a is the largest diameter and b and c are the other mutually perpendicular diameters and $$\:\text{V}\text{R}\text{R}=\frac{\text{i}\text{n}\text{i}\text{t}\text{i}\text{a}\text{l}\:\text{v}\text{o}\text{l}\text{u}\text{m}\text{e}\:-\:\text{l}\text{a}\text{s}\text{t}\:\text{v}\text{o}\text{l}\text{u}\text{m}\text{e}}{\text{i}\text{n}\text{i}\text{t}\text{i}\text{a}\text{l}\:\text{v}\text{o}\text{l}\text{u}\text{m}\text{e}}.$$ The resolution rate was defined as a VRR of > 50%. A VRR 90% was defined as cured. Statistical analysis The parametric quantitative variables between both groups were compared using Student’s t test, and repeated measures ANOVA and nonparametric variables were compared using the Mann–Whitney test. Within group changes were assessed by the Friedman test or by the Wilcoxon signed rank test. Qualitative variables were evaluated using χ2 tests. All analyses were performed with SPSS version 23 statistical software (IBM Corporation, Armonk, New York). Results Ninety-seven renal cysts were included in this study, including 92 cases of individual cysts and 5 cases of single cysts from ADPKD. Hydronephrosis was found in 5 patients (5.2%). The mean age was 66.85 years, ranging from 40 to 92 years. Fifty (51.5%) cysts were located in the right kidney, and 47 (48.5%) cysts were located in the left kidney. The initial cyst volume was 124.69 mL, ranging from 32.97 to 641.44 mL. The volume of 18 cysts (18.6%) was more than 300 mL. The combined group consisted of 70 patients with 74 cysts treated by ultrasound-guided 95% ethanol rinses and lauromacrogol injection, and the lauromacrogol group consisted of 20 patients with 23 cysts treated by ultrasound-guided lauromacrogol injection alone. The patients’ characteristics and baseline features of the cysts are summarized in Table 1 . The cytological examination was negative for neoplastic cells in all patients. All the cysts were followed up for at least 12 months. After ultrasound-guided sclerotherapy, the cysts in both groups shrank obviously. The changes in volume and VRR are listed in Table 2. At the 12 months follow-up, ninety-four of the 97 cysts (96.9%) had a VRR > 50% and achieved an efficient outcome, and eighty-eight of the 97 cysts (90.7%) had a VRR > 90% and were cured (Fig. 1 ). No significant differences in the resolution rate or cure rate were observed between the combined group and the lauromacrogol group, as shown in Table 2. Two failure cases involved cysts located at the upper pole of the kidney. Three cases of cysts (60%) from ADPKD were successful but not cured (Fig. 2 . ). A total of 47 complications listed in Table 3 were recorded across all 97 patients. Drowsiness, a major complication, was detected in the combined group. The predominant complications were procedure-related pain and sclerosants absorption fever. Other reported minor transient complications were haematuria and intracystic haemorrhage. A significant difference in the complication rate was observed between the combined group (58.1%) and the lauromacrogol group (17.4%). Although ethanol was only used to rinse the lumen of the cyst before lauromacrogol injection in the combined group, it was painful and prone to induce fever and drowsiness associated with therapy. All complications in both groups were relieved during the follow-up. Table 1 Characteristics of combined group and lauromacrogol group patients Characteristics Combined group Lauromcacrogol group P No.of patients 68 22 Age,years (range) 66.2 ± 9.54 69.0 ± 9.14 0.214* Gender,n(%) Male 40 (58.8%) 18 (81.8%) 0.05** Female 28 (41.2%) 4 (18.2%) Location,n(%) 74 23 Upper 29 (39.2%) 13 (56.5%) 0.214** Middle 17 (23.0%) 2 (8.7%) Lower 28 (37.8%) 8 (34.8%) Volume,n(%) 74 23 300ml 14 (18.9%) 4 (17.4%) Baseline volume,ml (range) 132.85 (40.28–600.2) 99.6(32.97-641.44) 0.212** * t test ** Chi-square test Table 2 Volume and VRR Changes at 1, 6 and 12 Months After Treatment according to the groups Follow-up item Baseline 1 months 6 months 12 months P Volume (mL) Combined group 132.85 (40.28–600.2) 23.95 (1.33-437.75) 3.26 (0-67.7) 0.60 (0-71.93) 0.87* Lauromacrogol group 99.6 (32.97-641.44) 16.47 (0.4-128.69) 1.03 (0-32.22) 0.58 (0-58.88) VRR (%) Combined group 83.4(12.37–96.93) 97.99(17.29–100) 99.62(12.12–100) 0.71* Lauromacrogol group 85.9(49.73–99.2) 98.94(70.21–100) 99.24(46.48–100) *repeated measures ANOVA Table 3 Complications of combined group and lauromacrogol group Complications Combined group Lauromcacrogol group P Total,n(%) 43(58.1%) 4(17.4%) 0.001* Pain,n(%) 16(21.6%) 0 Fever 24(32.4%) 3(13%) Haematuria 1(1.4%) 0 Drowsy 2(2.7%) 0 Intracystic hemorrage 0 1(4.3%) ** Chi-square test Discussion Renal cysts are a type of lesion that are easily detected by ultrasound in physical examination. The incidence of this disease increases gradually with age [ 1 ], ranging from 10–30% in adults to nearly 40% in people over 70 years old. They vary depending on their etiology, location and characteristics. Follow up is usually sufficient for most small simple renal cysts with insignificant clinical symptoms. Some people with peripelvic or parapelvic renal cysts can present with hydronephrosis when they are larger, whereas some aged people with large renal cysts can suffer from flank pain and hematuria if they have a history of trauma [ 2 , 11 ] . A definitive therapeutic method should be considered when those symptoms exist [ 12 ] . Currently, surgery is not recommended as the first-line choice for elderly patients because of its high risk and unbearable complications. Percutaneous sclerotherapy has been developed as a minimally invasive and efficient treatment with a low recurrence rate for cystic lesions in many different organs, including symptomatic renal cysts and even cysts from ADPKD [ 3 , 4 , 13 ] . Many types of sclerosants are used across different medical centers [ 3 , 4 ] . Owing to its quick action, ethanol at various concentrations is commonly administered in most studies [ 5 , 6 ] . Some studies have reported that the complications of ethanol are more obvious than those of a novel sclerosing agent, lauromacrogol [ 8 , 14 ] . With the leakage of ethanol into the surrounding tissue, minor complications, such as pain due to local tissue corrosion, fever and microscopic hematuria, and major complications, such as drowsiness, may occur [ 4 , 6 ] . Lauromacrogol, a surfactant sclerosing agent, can have strong antiangiogenic effects in vitro and in vivo [ 15 ] , produce significant regression of the endometrial foci [ 16 ] , and cause fibrosis in the thyroid or other connective tissue [ 17 ] . Therefore, this sclerosant has been adopted in a variety of organs and clinical conditions, even for off-label use [ 18 ] . Our former study confirmed that ultrasound-guided percutaneous lauromacrogol injection is an effective treatment for cystic thyroid nodules [ 10 ] . As a nonester local anaesthetic, lauromacrogol is painless upon injection and has a low risk for necrosis with extravasation [ 9 ] . Some studies have demonstrated that polidocanol is a safe sclerosing agent in the short and long term, regardless of its use as a liquid or foam [ 19 , 20 ] . It can even be administered in the treatment of patients with autosomal dominant polycystic renal diseases [ 13 ] . Our study showed similar results. We found that a single lauromacrogol injection had equal efficacy and better safety than the combination of a 95% ethanol rinse and lauromacrogol injection. The incidence of transient fever in the lauromacrogol alone group was much lower than that in the combined group. The pain associated with a single lauromacrogol injection is minor and easily resolved. In our study, a higher success rate and a lower complication rate were found in both groups than in those reported in previous studies. There are several factors that may affect these results. In our clinical experience, accurate insertion is the key factor in therapeutic success. Yongue reported that percutaneous sclerotherapy for upper pole cysts is not as effective as that for middle and lower pole cysts because of difficulty in approach and inadequate aspiration[8]. We initially encountered the same obstacle as Yongue did, but later developed an alternative route to insert the needle into the upper pole cysts accurately via the lateral or posterior back approach. It is much easier to avoid dangerous areas such as the upper poles near the spleen and perihilar region through the anterior-back route. In such cases, people do not need to hold their breath strictly because of a lack of respiratory mobility. Second, adequate aspiration and rinse are neccessary to ensure the concentration of the sclerasants and reach therapeutic efficacy. We often rinse the lumen of the cysts several times with saline until the aspirated fluid is clear. Moreover, a rigid 20-gauge puncture needle less than 1 mm in diameter was used instead of a pig-tail catheter or an 18-gauge needle. Even though it is more difficult to aspirate than the thicker one, injury from the insertion with a 20-gauge puncture needle will be less common than before. In this study, there were still some cases of anatomical failure defined as < 50% reduction, or partial success defined as 50–90% reduction in cyst volume. In addition to the location of the cyst, the initial volume, characteristics of the cyst and the clinical experience of the operator are impact factors of success. During the preliminary period of the study, 2 cases of upper pole aspiration and 1 case of inadequate aspiration failed because of limitations in operative skills. Later, 3 cases of ADPKD were partially reduced because of compression of the surrounding tissue, and 1 case in which the initial volume was greater than 300 mL partially decreased because of the insufficiency of the sclerosant. Accordingly, complications such as pain and intracystic haematuria often occur in patients with therapeutic failure, especially in the combined group. This occurred because of the leakage of ethanol and accidental insertion into other surrounding tissues. Postoperative minor fever and drowsiness usually occur in large renal cysts resulting from rinses with ethanol. In addition, heavy trauma should be avoided after interventional treatment, especially in elderly patients who receive anticoagulant therapy preoperatively. Our study has several limitations. This was a retrospective study with a relatively small sample size. Some related factors, such as the form of sclerosants and other native characteristics of the cysts, which can influence the efficacy and safety of sclerotherapy, were not analysed sufficiently. This study was also limited in the clinical experience of large renal cyst cases. Conclusions In conclusion, percutaneous 95% ethanol rinses combined with lauromacrogol injection and lauromacrogol injection alone can achieve similar therapeutic success rates. Even though ethanol is used for flushing the lumen of cysts only, the incidence of complications is much higher than that of simple laurumacrogol injection. Abbreviations VRR volume reduction rate ADPKD Autosomal Dominant Polycystic Kidney Disease Declarations Clinical trial number Not applicable. Ethics approval and consent to participate This retrospective study was approved by the Institutional Review Board of our hospital. Informed consent was obtained from all patients before ultrasound-guided percutaneous sclerosant injection of simple renal cysts in elderly individuals. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interestsFunding Funding Not applicable. Authors’ contributions FL W and KG performed the sclerotherapy procedure, and KG was a major contributor to the manuscript. NL X and WD D reviewed and revised the manuscript. All authors have read and approved the final version of the manuscript. Acknowledgments We sincerely thank our colleagues from the Clinical Trial Research Center, the Departments of Nephrology, and the ultrasound department of the Beijing hospital for their assistance with this study. Researcher Zhao, Drs Wang, Fan, and Shui contributed equally to this work. References Hommos MS, Glassock RJ, Rule AD. Structural and Functional Changes in Human Kidneys with Healthy Aging. J Am Soc Nephrol. 2017;28:2838–44. 10.1681/ASN.2017040421 . Terada N, Arai Y, Kinukawa N. e tal. The 10-year natural history of simple renal cysts. Urology. 2008; 71: 7–11. 10.1016/j.urology.2007.07.075 Dietrich CF, Chiorean L. Potthoff A e tal. Percutaneous sclerotherapy of liver and renal cysts, comments on the EFSUMB guidelines. Z Gastroenterol. 2016;54:155–66. 10.1055/s-0041-106594 . Brown D, Nalagatla S, Stonier T. e tal. Radiologically guided percutaneous aspiration and sclerotherapy of symptomatic simple renal cysts: a systematic review of outcomes. 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Doganci S, Yildirim V, Erol G. e tal. Polidocanol (Lauromacrogol 400) has anti-angiogenic effects in vitro and in vivo. Eur Rev Med Pharmacol Sci. 2016;20:1384–9. Liu W, Wang L, Guo CX. The effects of lauromacrogol injection into rat endometrial cysts: a preliminary experimental study. Arch Gynecol Obstet. 2016;294:555–9. 10.1007/s00404-016-4095-9 . Idiz UO, Aysan E. Can I e tal. The effects of lauromacrogol on thyroid tissue in rabbits. Is this a safe option for the treatment of nodular thyroid disease? Ann Ital Chir. 2016;87:192–7. Ebrahimi SRS, Enamzadeh E, Babaei H. An Evidence-Based Review of Off-Label Uses of Polidocanol. Curr Clin Pharmacol. 2017;12:223–30. 10.2174/1574884713666180223121828 . Guex JJ, Schliephake DE, Otto J. e tal. The French polidocanol study on long-term side effects: a survey covering 3,357 patient years. Dermatol Surg. 2010;36:993–1003. 10.1111/j.1524-4725.2009.01407.x . Nastasa V, Samaras K. Ampatzidis Ch e tal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5280608","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369604301,"identity":"c18c2f0e-57c1-4b7b-9269-b306b22ce493","order_by":0,"name":"Kan Gao","email":"","orcid":"","institution":"Beijing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kan","middleName":"","lastName":"Gao","suffix":""},{"id":369604302,"identity":"285dd3c9-de25-48d7-ab02-06a854bfb529","order_by":1,"name":"Feiliang Wang","email":"","orcid":"","institution":"Beijing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Feiliang","middleName":"","lastName":"Wang","suffix":""},{"id":369604304,"identity":"589731eb-ff35-4eab-bede-226c6828c354","order_by":2,"name":"Lengnan Xu","email":"","orcid":"","institution":"Beijing Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lengnan","middleName":"","lastName":"Xu","suffix":""},{"id":369604306,"identity":"c427eca4-5725-4aa1-95b8-48dde7c371a8","order_by":3,"name":"Weide Dai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDCCA4wNQFKCsYG9sfHBB9K08BxuNpxBnBYIxdggkd4mzUGMDr7jhxuYeSosZPslHzZIMzDYyek2ENAieSYRqOWMhPHM2YkNxgUMycZmBwhoMTgA1JLbJpG44XZiQ/IMhgOJ2whqOf8QqOWfROL+mwcbDvMQpeUGyJYGoC0SjI3NRGmRvPGw4fCfYxLGM84kNjPOMCDCL3zn0x8+nFFTJ9vffvz5jw8VdnIEtYAAkhoDIpSPglEwCkbBKCAMAGn2ScPDrn03AAAAAElFTkSuQmCC","orcid":"","institution":"Beijing Hospital","correspondingAuthor":true,"prefix":"","firstName":"Weide","middleName":"","lastName":"Dai","suffix":""}],"badges":[],"createdAt":"2024-10-17 07:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5280608/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5280608/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67371628,"identity":"884b4e48-29ad-4393-a878-20d2ff759db4","added_by":"auto","created_at":"2024-10-24 07:57:16","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":771136,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound image from a 57-year-old female with a single cyst. A, Before treatment measured 9.0cm × 7.8 cm in the lower pole of left kidney. B, At 1 months. C, At 6 months. D, At 12 months, the cyst decreased substantially, and cavity of the cyst disappeared.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5280608/v1/52e13e9e0efdf84afbbf2da4.jpeg"},{"id":67371627,"identity":"fae2817c-7dbd-47d7-a6cf-9993ecdb4d02","added_by":"auto","created_at":"2024-10-24 07:57:16","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":621531,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound image from a 40-year-old female with a single cyst from ADPKD. A, Before treatment measured 8.6cm × 8.1 cm in the lower pole of left kidney. B , At 1 months. C, At 6 months. D, At 12 months, the cyst shrank gradually, but did not disappear measured 4.8cm × 4.5cm.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5280608/v1/c1a6a1a34fd17162bb4bee04.jpeg"},{"id":67372056,"identity":"58bc8260-e49f-42fc-94e4-1db80c5de313","added_by":"auto","created_at":"2024-10-24 08:05:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1874303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5280608/v1/32372dfc-2478-4964-a0a0-8fdedab5ba25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"95% ethanol rinses combined with lauromacrogol injection versus lauromacrogol injection alone in the ultrasound-guided percutaneous sclerotherapy for simple renal cysts in elderly patients：Which is safer and more effective?","fulltext":[{"header":"Background","content":"\u003cp\u003eSimple renal cysts are common benign diseases in elderly patients, and their prevalence is strongly associated with age\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Some large renal cysts (\u0026gt;\u0026thinsp;5 cm in diameter) induce flank/back pain, hematuria, hypertension and pelvicalyceal obstruction, depending on their specific location\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Ultrasound-guided sclerotherapy, a common minimally invasive treatment, has recently been confirmed to be a successful and safe procedure for treating symptomatic renal cysts, especially in the elderly population, who are at increased risk of anaesthesia\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Ethanol has been confirmed as the most commonly administered agent at various concentrations\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. At high concentrations, ethanol can destroy epithelial cells in the cystic wall within minutes\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, but the complications are more obvious, which includes mild or moderate pain during the operation and a mild and transient fever within several days after the procedure\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Lauromacrogol was first used as a local anaesthetic, was adopted as a painless sclerosant in many fields and has been reported to have a low incidence of allergic effects\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Rare literatures were reported about the comparison of 2 combined agents and 1 separate agent in one trial. In this study, we compared the efficacy and safety of the use of 95% ethanol rinses combined with lauromacrogol injection and lauromacrogol injection alone in ultrasound-guided percutaneous sclerotherapy for treating senile renal cysts.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eNinety-seven simple renal cysts between March 2019 and June 2023 were included in this retrospective study, treated with ultrasound-guided percutaneous sclerosant injection and followed up till 12 months.\u003c/p\u003e \u003cp\u003eThis study aim to compare the efficacy and safety of combination of 95% ethanol and lauromacrogol and lauromacrogol alone in percutaneous sclerotherapy of simple renal cysts in elderly individuals during 12 months period.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003ePatients were selected according to the following criteria: (1) symptomatic Bosniak type I and II renal cysts with a maximum diameter larger than 50 mm on ultrasound; (2) a history with presenting symptoms induced by renal cysts, such as pain, intracystic haemorrahge or infection, and hydronephrosis; (3) predominant cysts inducing flank/back pain from autosomal dominant polycystic kidney disease (ADPKD). The exclusion criteria were as follows: (1) allergy to alcohol and lauromacrogol; (2) pregnancy; (3) patients with serious cardiovascular or cerebrovascular diseases, severe mental disorders, and inability to tolerate the treatments; (4) recent anticoagulation treatment, severe coagulopathy, and bleeding tendencies; and (5) systemic symptoms of infection such as fever or the use of cephalosporins.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eRenal ultrasound examination focused on the sonographic features of the target cysts was performed, and the best puncture route was carefully evaluated before treatment. Ultrasound-guided sclerotherapy was subsequently carried out in an outpatient clinic. The patients were placed supine, in a lateral decubitus position, and under local anaesthesia with 3% lidocaine. A 20-gauge puncture needle was inserted into the cyst under ultrasound guidance and connected to a T-junction, connecting tube and 60-ml plastic syringe. Ten milliliters of fluid from the cyst was aspirated and used for the protein coagulation test. If the result was positive, the cyst was confirmed to have no communication with the pelvicaliceal system, and it was aspirated completely. After that, in the combined group, 95% ethanol in a volume equivalent to 20% of the cyst volume (to a maximum of 20 mL) was instilled, the lumen of the cyst was rinsed repeatedly, and the mixture was reaspirated. Afterwards, lauromacrogol (lauromacrogol injection, 10 mL:100 mg; Tianyu Pharmaceutical Co. Ltd., Shanxi, China) was injected and remained in the cysts. In the lauromacrogol group, only lauromacrogol was instilled and remained in the lumen of the cyst. The volume of lauromacrogol (liquid or foam) was equivalent to 30% of the cyst volume (to a maximum of 60 mL). The patients were asked to apply pressure over the puncture site for 20 minutes and leave the clinic without regional bleeding on ultrasound scanning.\u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eThe complications were evaluated within 3 days after sclerotherapy. The patients were followed up at 1 month, 6 months, and 12 months. The volume of the nodules was evaluated by ultrasound examination before treatment and at 1, 6 and 12 months of follow-up. The volume of each nodule and the volume reduction rate (VRR) were calculated via the following equations: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{v}\\text{o}\\text{l}\\text{u}\\text{m}\\text{e}\\:=\\:\\frac{{\\pi\\:}\\:\\text{a}\\text{b}\\text{c}}{6}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003ewhere a is the largest diameter and b and c are the other mutually perpendicular diameters and\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\text{V}\\text{R}\\text{R}=\\frac{\\text{i}\\text{n}\\text{i}\\text{t}\\text{i}\\text{a}\\text{l}\\:\\text{v}\\text{o}\\text{l}\\text{u}\\text{m}\\text{e}\\:-\\:\\text{l}\\text{a}\\text{s}\\text{t}\\:\\text{v}\\text{o}\\text{l}\\text{u}\\text{m}\\text{e}}{\\text{i}\\text{n}\\text{i}\\text{t}\\text{i}\\text{a}\\text{l}\\:\\text{v}\\text{o}\\text{l}\\text{u}\\text{m}\\text{e}}.$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe resolution rate was defined as a VRR of \u0026gt;\u0026thinsp;50%.\u003c/p\u003e \u003cp\u003eA VRR\u0026thinsp;\u0026lt;\u0026thinsp;50% was defined as noneffective, 50\u0026ndash;90% was defined as effective, and \u0026gt;\u0026thinsp;90% was defined as cured.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe parametric quantitative variables between both groups were compared using Student\u0026rsquo;s t test, and repeated measures ANOVA and nonparametric variables were compared using the Mann\u0026ndash;Whitney test. Within group changes were assessed by the Friedman test or by the Wilcoxon signed rank test. Qualitative variables were evaluated using χ2 tests. All analyses were performed with SPSS version 23 statistical software (IBM Corporation, Armonk, New York).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eNinety-seven renal cysts were included in this study, including 92 cases of individual cysts and 5 cases of single cysts from ADPKD. Hydronephrosis was found in 5 patients (5.2%). The mean age was 66.85 years, ranging from 40 to 92 years. Fifty (51.5%) cysts were located in the right kidney, and 47 (48.5%) cysts were located in the left kidney. The initial cyst volume was 124.69 mL, ranging from 32.97 to 641.44 mL. The volume of 18 cysts (18.6%) was more than 300 mL. The combined group consisted of 70 patients with 74 cysts treated by ultrasound-guided 95% ethanol rinses and lauromacrogol injection, and the lauromacrogol group consisted of 20 patients with 23 cysts treated by ultrasound-guided lauromacrogol injection alone. The patients\u0026rsquo; characteristics and baseline features of the cysts are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The cytological examination was negative for neoplastic cells in all patients.\u003c/p\u003e \u003cp\u003eAll the cysts were followed up for at least 12 months. After ultrasound-guided sclerotherapy, the cysts in both groups shrank obviously. The changes in volume and VRR are listed in Table\u0026nbsp;2. At the 12 months follow-up, ninety-four of the 97 cysts (96.9%) had a VRR\u0026thinsp;\u0026gt;\u0026thinsp;50% and achieved an efficient outcome, and eighty-eight of the 97 cysts (90.7%) had a VRR\u0026thinsp;\u0026gt;\u0026thinsp;90% and were cured (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No significant differences in the resolution rate or cure rate were observed between the combined group and the lauromacrogol group, as shown in Table\u0026nbsp;2. Two failure cases involved cysts located at the upper pole of the kidney. Three cases of cysts (60%) from ADPKD were successful but not cured (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. ).\u003c/p\u003e \u003cp\u003eA total of 47 complications listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e were recorded across all 97 patients. Drowsiness, a major complication, was detected in the combined group. The predominant complications were procedure-related pain and sclerosants absorption fever. Other reported minor transient complications were haematuria and intracystic haemorrhage. A significant difference in the complication rate was observed between the combined group (58.1%) and the lauromacrogol group (17.4%). Although ethanol was only used to rinse the lumen of the cyst before lauromacrogol injection in the combined group, it was painful and prone to induce fever and drowsiness associated with therapy. All complications in both groups were relieved during the follow-up.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of combined group and lauromacrogol group patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLauromcacrogol group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge,years (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.214*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (39.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.214**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVolume,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;300ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (82.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;300ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline volume,ml (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132.85 (40.28\u0026ndash;600.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.6(32.97-641.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.212**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003et\u003c/em\u003e test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;2 Volume and VRR Changes at 1, 6 and 12 Months After Treatment according to the groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up item\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVolume (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132.85 (40.28\u0026ndash;600.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.95 (1.33-437.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.26 (0-67.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.60 (0-71.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.87*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLauromacrogol group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.6 (32.97-641.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.47 (0.4-128.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03 (0-32.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.58 (0-58.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVRR (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.4(12.37\u0026ndash;96.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.99(17.29\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e99.62(12.12\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.71*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLauromacrogol group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.9(49.73\u0026ndash;99.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.94(70.21\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e99.24(46.48\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*repeated measures ANOVA\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications of combined group and lauromacrogol group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombined group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLauromcacrogol group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaematuria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrowsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntracystic hemorrage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRenal cysts are a type of lesion that are easily detected by ultrasound in physical examination. The incidence of this disease increases gradually with age\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e],\u003c/sup\u003e ranging from 10\u0026ndash;30% in adults to nearly 40% in people over 70 years old. They vary depending on their etiology, location and characteristics. Follow up is usually sufficient for most small simple renal cysts with insignificant clinical symptoms. Some people with peripelvic or parapelvic renal cysts can present with hydronephrosis when they are larger, whereas some aged people with large renal cysts can suffer from flank pain and hematuria if they have a history of trauma\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. A definitive therapeutic method should be considered when those symptoms exist\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Currently, surgery is not recommended as the first-line choice for elderly patients because of its high risk and unbearable complications. Percutaneous sclerotherapy has been developed as a minimally invasive and efficient treatment with a low recurrence rate for cystic lesions in many different organs, including symptomatic renal cysts and even cysts from ADPKD\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Many types of sclerosants are used across different medical centers\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Owing to its quick action, ethanol at various concentrations is commonly administered in most studies\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Some studies have reported that the complications of ethanol are more obvious than those of a novel sclerosing agent, lauromacrogol\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. With the leakage of ethanol into the surrounding tissue, minor complications, such as pain due to local tissue corrosion, fever and microscopic hematuria, and major complications, such as drowsiness, may occur\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Lauromacrogol, a surfactant sclerosing agent, can have strong antiangiogenic effects in vitro and in vivo\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, produce significant regression of the endometrial foci\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, and cause fibrosis in the thyroid or other connective tissue\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Therefore, this sclerosant has been adopted in a variety of organs and clinical conditions, even for off-label use\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Our former study confirmed that ultrasound-guided percutaneous lauromacrogol injection is an effective treatment for cystic thyroid nodules\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. As a nonester local anaesthetic, lauromacrogol is painless upon injection and has a low risk for necrosis with extravasation\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Some studies have demonstrated that polidocanol is a safe sclerosing agent in the short and long term, regardless of its use as a liquid or foam\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. It can even be administered in the treatment of patients with autosomal dominant polycystic renal diseases\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Our study showed similar results. We found that a single lauromacrogol injection had equal efficacy and better safety than the combination of a 95% ethanol rinse and lauromacrogol injection. The incidence of transient fever in the lauromacrogol alone group was much lower than that in the combined group. The pain associated with a single lauromacrogol injection is minor and easily resolved.\u003c/p\u003e \u003cp\u003eIn our study, a higher success rate and a lower complication rate were found in both groups than in those reported in previous studies. There are several factors that may affect these results. In our clinical experience, accurate insertion is the key factor in therapeutic success. Yongue reported that percutaneous sclerotherapy for upper pole cysts is not as effective as that for middle and lower pole cysts because of difficulty in approach and inadequate aspiration[8]. We initially encountered the same obstacle as Yongue did, but later developed an alternative route to insert the needle into the upper pole cysts accurately via the lateral or posterior back approach. It is much easier to avoid dangerous areas such as the upper poles near the spleen and perihilar region through the anterior-back route. In such cases, people do not need to hold their breath strictly because of a lack of respiratory mobility. Second, adequate aspiration and rinse are neccessary to ensure the concentration of the sclerasants and reach therapeutic efficacy. We often rinse the lumen of the cysts several times with saline until the aspirated fluid is clear. Moreover, a rigid 20-gauge puncture needle less than 1 mm in diameter was used instead of a pig-tail catheter or an 18-gauge needle. Even though it is more difficult to aspirate than the thicker one, injury from the insertion with a 20-gauge puncture needle will be less common than before.\u003c/p\u003e \u003cp\u003eIn this study, there were still some cases of anatomical failure defined as \u0026lt;\u0026thinsp;50% reduction, or partial success defined as 50\u0026ndash;90% reduction in cyst volume. In addition to the location of the cyst, the initial volume, characteristics of the cyst and the clinical experience of the operator are impact factors of success. During the preliminary period of the study, 2 cases of upper pole aspiration and 1 case of inadequate aspiration failed because of limitations in operative skills. Later, 3 cases of ADPKD were partially reduced because of compression of the surrounding tissue, and 1 case in which the initial volume was greater than 300 mL partially decreased because of the insufficiency of the sclerosant. Accordingly, complications such as pain and intracystic haematuria often occur in patients with therapeutic failure, especially in the combined group. This occurred because of the leakage of ethanol and accidental insertion into other surrounding tissues. Postoperative minor fever and drowsiness usually occur in large renal cysts resulting from rinses with ethanol. In addition, heavy trauma should be avoided after interventional treatment, especially in elderly patients who receive anticoagulant therapy preoperatively.\u003c/p\u003e \u003cp\u003eOur study has several limitations. This was a retrospective study with a relatively small sample size. Some related factors, such as the form of sclerosants and other native characteristics of the cysts, which can influence the efficacy and safety of sclerotherapy, were not analysed sufficiently. This study was also limited in the clinical experience of large renal cyst cases.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, percutaneous 95% ethanol rinses combined with lauromacrogol injection and lauromacrogol injection alone can achieve similar therapeutic success rates. Even though ethanol is used for flushing the lumen of cysts only, the incidence of complications is much higher than that of simple laurumacrogol injection.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evolume reduction rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADPKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutosomal Dominant Polycystic Kidney Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by the Institutional Review Board of our hospital. Informed consent was obtained from all patients before ultrasound-guided percutaneous sclerosant injection of simple renal cysts in elderly individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interestsFunding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFL W and KG performed the sclerotherapy procedure, and KG was a major contributor to the manuscript. NL X and WD D reviewed and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank our colleagues from the Clinical Trial Research Center, the Departments of Nephrology, and the ultrasound department of the Beijing hospital for their assistance with this study. Researcher Zhao, Drs Wang, Fan, and Shui contributed equally to this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHommos MS, Glassock RJ, Rule AD. Structural and Functional Changes in Human Kidneys with Healthy Aging. 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Properties of polidocanol foam in view of its use in sclerotherapy. Int J Pharm. 2015;478:588\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijpharm.2014.11.056\u003c/span\u003e\u003cspan address=\"10.1016/j.ijpharm.2014.11.056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"renal cyst, 95% ethanol, lauromacrogol, scleratherapy, ultrasound","lastPublishedDoi":"10.21203/rs.3.rs-5280608/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5280608/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo compare the effcacy and safety of 95% ethanol rinses combined lauromacrogol injection and lauromacrogol injection alone in scleratherapy of renal cyst.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analysed 97 symptomatic Bosniak type I renal cysts between 2019 and 2023 underwent by US-guided percutaneous sclerotherapy. 23 cases were treated by lauromacrogol injection alone, and 74 were treated by 95% ethanol rinses combined lauromacrogol injection. All cysts were followed up at 1, 6 and 12 months after the procedure. Success was defined as cured or effective: \u0026gt;90% reduction or 50\u0026ndash;90% reduction in cyst size, respectively. Failure was defined as \u0026lt;\u0026thinsp;50% reduction in cyst size. Intraoperative pain, fever, drowsy, and minor hematuria defined as complication were assessed within 3 days after the operation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe volume of renal cysts tended to shrink during follow-up. The total resolution rate and the cure rate was 96.9% (94/97) and 90.7% (88/97), respectively at 12 months. No significant differences in the reduction of volume reduction rate, resolution rate and cure rate were observed between the groups during follow-up (P\u0026thinsp;\u0026gt;\u0026thinsp;.05). The complication rates for ethanol combined group 58.1% (43/74) were higher than those for lauromacrogol alone group 17.4% (4/23) (P\u0026thinsp;\u0026lt;\u0026thinsp;.05). Ethanol was found to be significantly painful and prone to cause fever, even used to rinse the lumen of simple renal cysts before lauromacrogol injection .\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSuccess of percutaneous scleratherapy of renal cysts can be obtained in two groups. However, the safety was much higher in lauromacrogol injection alone.\u003c/p\u003e","manuscriptTitle":"95% ethanol rinses combined with lauromacrogol injection versus lauromacrogol injection alone in the ultrasound-guided percutaneous sclerotherapy for simple renal cysts in elderly patients：Which is safer and more effective?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-24 07:57:10","doi":"10.21203/rs.3.rs-5280608/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T14:23:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-25T11:16:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T10:09:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2026-04-15T10:30:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46309285344871789601589018807869500564","date":"2026-04-01T06:53:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T12:47:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191493436427106222139010339955840067900","date":"2026-03-12T13:21:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186810409527165759629585221511500969503","date":"2026-03-10T11:57:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-14T08:25:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192510217257043023174736480503042098082","date":"2024-12-04T13:07:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-27T07:49:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-23T04:47:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-22T12:57:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-22T12:55:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-10-17T07:23:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aaaf2a73-29d5-4b3c-88f5-29018fb27d18","owner":[],"postedDate":"October 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T14:40:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-24 07:57:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5280608","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5280608","identity":"rs-5280608","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}