Contraindications and patient preparation are identical to those described for nephrostomy insertion (see Chapter 3g—Neph-rostogram). A single dose of a prophylactic antibiotic agent must be administered.

• A 21-22-gauge needle is inserted percutaneously under local anesthesia (1% lidocaine)

• Laparoscopic cyst de-roofing requires a general anesthetic

• When using a needle, cyst localization is achieved using a combination of USS (most common), CT, or fluoroscopy

• Once the cyst is punctured, the fluid is aspirated

■ Simple cyst fluid is clear and straw-colored

(i) Hemorrhage into a simple cyst

(ii) Traumatic puncture

(iii) Hematoma

(iv) Complex/malignant cyst

• Although many operators will terminate the procedure at this stage, injection of 1-2 ml of contrast into the cyst may help clarify the anatomy

• If no aspiration is possible, in spite of correct placement, the mass is assumed to be solid in consistency (about 25% will eventually prove to be malignant)

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Dealing With Erectile Dysfunction

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