Diagnosis and laparoscopic treatment of renal cysts of Bosniak type III and IV

A total of 322 patients with cystic lesions were examined with contrast-enhanced computed tomography from 1998 to 2005. Of them, 104 patients have undergone transperitoneal or retroperitonial laparoscopic surgery. 21 patients of the latter were diagnosed to have cystic lesions Bosniak III and 4 patients--Bosniak IV. It is difficult to differentiate cysts Bocniak II and III even pathomorphologically. Cystic carcinoma was detected histologically in 8 Bosniak III cases. Partial nephrectomy was made in 7 cases and radical nephrectomy in 1 case. Renal cell carcinoma was detected in 3 of 4 Bosniak IV cases, oncocytoma--in 1 case. Thus, renal cancer was confirmed in 8 cases (38%) of Bosniak III and 3 cases of Bosniak IV. During the mean follow-up of 40 months no events of local recurrence, progression or tumor growth in places of trocar installation were detected. Cases of cancer specific mortality were not observed. Cystic lesion Bosniak III and IV are subject for surgical treatment. The method of choice is laparoscopic transperitoneal partial nephrectomy and radical nephrectomy.