Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent inherited disease of kidney in adults. Approximately, 30-50 percent of these patients will have one or more urinary tract infections during their lifetime. Treatment is somewhat more complicated with an infected cyst and if the patient doesn't respond to antimicrobial therapy, surgical nephrectomy is the treatment of last resort.

Case report: In this article, we report a 56 year old woman with ADPKD and diabetes. The patient had multiple pyocysts and didn't respond to antimicrobial therapy. The cysts were drained and washed under sonography guidance and the patient was treated.

Conclusion: Drainage of pyocysts in ADPKD with sonographic guide and frequent rinsing can be a good replacement for nephrectomy in patients that don't respond to antimicrobial therapy and are candidates for nephrectomy.