STS Sclerotherapy for Renal Cyst Volume Reduction in Autosomal Dominant Polycystic Kidney Disease

Sunday, March 5, 2023

4:12 PM – 4:21 PM

Location: Phoenix Convention Center, 225AB

Presenting Author(s)

RC

Ross Copping, MBBS BBiomedSc FRANZCR (he/him/his)

Interventional Radiology Fellow
University Health Network (University of Toronto)

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Eran Shlomovitz, MD FACS

Surgeon Interventional Radiologist
Toronto General Hospital
ET

Elizabeth Tai, MD

Interventional Radiologist
University Health Network (University of Toronto)

Disclosure(s):

Ross Copping, MBBS BBiomedSc FRANZCR: No financial relationships to disclose

Purpose: To determine if sodium tetradecyl sulfate (STS) sclerotherapy causes effective renal cyst volume reduction in autosomal dominant polycystic kidney disease (ADPKD) and investigate the pathologic mechanism of action of STS sclerotherapy using a porcine bladder model.

Materials and Methods:
In this retrospective study, 282 ADPKD patients were treated with sclerotherapy over an 8-year period (2014-2022). 416 cysts were treated in total with 3% STS, using either one or two stage approach depending on cyst size. Mean age was 53 ± 11 years. To assess efficacy of STS sclerotherapy, renal cyst volume was measured on pre-procedure, post-procedure and last available magnetic resonance imaging (MRI).
To investigate the mechanism of action of STS sclerotherapy, a porcine bladder model was evaluated using pre- and post-procedural confocal laser endomicroscopy and formalin-fixed hematoxylin and eosin (H&E) staining of treated and control tissue.

Results: Of the analysed data, one- and two-stage sclerotherapy resulted in 90% and 89% (p < 0.001) cyst volume reduction (one-stage pre 154 ± 17mL, post 15 ± 2.3mL; two-stage pre 340 ± 43mL, post 37 ± 11.5mL) respectively. STS sclerotherapy is effective longer-term (average follow-up 844 days) resulting in 89% decrease on the first follow-up MRI (average 150 ± 13 days) and 95% decrease in volume on the last MRI (p < 0.001). Porcine bladder model, confocal endomicroscopy and H&E staining demonstrate near complete denudation of the epithelial layer with superficial inflammatory changes and vascular congestion in the lamina propria.

Conclusion: STS sclerotherapy is effective treatment for short- and long-term reduction of renal cyst volume in ADPKD patients. The acute phase mechanism of STS sclerotherapy is denudation of the epithelial layer, local inflammation and vascular congestion in the lamina propria.