What is the treatment approach for cystoclysis (cyst dissolution)?

Cystoclysis: Clarification and Treatment Approach

The term "cystoclysis" appears to be a misunderstanding or mistranslation—this term traditionally refers to bladder irrigation/lavage, not cyst dissolution. Based on the context provided, I will address the most clinically relevant interpretations:

If Referring to Bladder Irrigation (Traditional Cystoclysis)

Bladder irrigation is primarily a supportive measure used for clot evacuation, hemorrhagic cystitis management, or post-operative care following bladder procedures. 1

Indications and Technique

• Continuous bladder irrigation is performed using a three-way catheter with sterile saline solution to prevent clot formation and maintain catheter patency following transurethral resection of bladder tumors (TURBT) 1
• The irrigation rate should be adjusted to maintain clear or light pink urine output 1

If Referring to Cyst Dissolution/Treatment

Renal/Urinary Tract Cystine Stone Dissolution

For cystine calculi specifically, percutaneous nephrostomy with chemical dissolution using tromethamine-E is more effective than acetylcysteine-bicarbonate solution. 2

• Tromethamine-E irrigation achieved complete dissolution in 3 of 5 attempts (60% success rate) compared to acetylcysteine-bicarbonate which succeeded in only 2 of 6 attempts (33% success rate) 2
• Irrigation time ranges from 6 to 42 days for successful dissolution 2
• This approach is reserved for symptomatic, obstructing cystine stones as an alternative to surgical intervention 2

Digital Mucous Cysts (If Referring to Peripheral Cysts)

Surgical excision remains the gold standard with 95% cure rates, significantly superior to all non-surgical approaches. 3

Treatment Algorithm by Line of Therapy:

• First-line: Surgical excision (95% cure rate) 3
• Second-line: Sclerotherapy with polidocanol 3% (77.8% complete resolution at 12 weeks) or cryotherapy (72% cure rate) 3, 4
• Third-line: Corticosteroid injection (61% cure rate) or simple expression of cyst contents (39% cure rate) 3

Hydatid Cyst Disease (Echinococcosis)

For hepatic hydatid cysts >5 cm, PAIR (Puncture, Aspiration, Injection, Re-aspiration) combined with albendazole 400 mg twice daily is the recommended approach. 1

• Albendazole alone is recommended for cysts <5 cm in diameter 1
• Praziquantel 20 mg/kg twice daily should be added for 2 weeks pre- and post-aspiration or surgery 1
• Late-stage cysts (WHO type 4 or 5) may be managed with observation and sequential ultrasound monitoring 1

Common Pitfalls and Caveats

• Avoid attempting chemical dissolution for non-cystine urinary stones—this approach is specific to cystine calculi and ineffective for calcium-based stones 2
• Mixed composition stones may fail chemical dissolution—one case with calcium oxalate shell failed tromethamine-E treatment entirely 2
• For digital mucous cysts, simple drainage has the highest recurrence rate (61% failure)—definitive treatment requires either surgery or sclerotherapy 3
• Hydatid cyst aspiration carries risk of anaphylaxis and peritoneal dissemination—treatment should only be performed in specialist centers with appropriate precautions 1