### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, I m a 62yr caucasian male. A recent US showed 4 benign cysts. 6.8cm,2.4cm.1.6cn on interpolar left and 1.7cm on parapelvic right. All have grown since my last US 2 years ago. My creatinine is 1.69. I have had 3 episodes of PE s, 4 episodes of DVT s in 4 years. I am now on warfarin with INR 2.9. I have spinal stenosis from an old L1 burst fracture. I have lower back leg pain and muscle cramps. I m concerned about complications if I have the cysts aspirated. Managing the pain requires quite a bit of narcotic pain meds which cause constipation and then additional pain. Could the aspiration reduce the pain level? What other concerns could the procedure cause?

### output:

Hi, Cysts aspiration may definitely give you symptomatic relief. These large cysts may press on the pelvic structures, and I am suspecting that these have caused pressure on ureters since long contributing to urine outflow obstruction and therefore deranged creatinine. Apart from this, these also cause pressure on the pelvic venous plexuses causing venous stasis and thus prone you to DVT and PE risk. As you are on Warfarin, cysts aspiration like any other surgical procedure carries some risk like hemorrhage into the cyst or intra-abdominal bleeding. However, it can be managed by adjusting or stopping the Warfarin perioperative and bridging it with IV Heparin. Don't forget to restart Warfarin after no issues with bleeding, after the procedure because a second episode of PE may occur as you have already experienced one. Hope I have answered your query. Let me know if I can assist you further. 