Conservative and radiological management of simple renal cysts: a comprehensive review

Abstract

What's known on the subject? and What does the study add? Simple renal cysts are a common entity, which may need observation and follow‐up or treatment. The study, for the first time, systematically reviews the indications for follow‐up or radiological treatment of simple renal cysts. To review the conservative and radiological management of simple renal cysts a systematic literature review was performed. Simple renal cysts are commonly found in the adult population. Increasing age is highly associated with its incidence. When they remain asymptomatic they require neither treatment nor follow‐up. When the shape of the cyst is slightly irregular follow‐up is mandatory to exclude malignant progression. Symptomatic cysts require intervention. Ultrasound or computed tomography guidance have been effectively used for cyst puncture. However, simple fluid aspiration is ineffective leading to cyst recurrence. Aspiration should be accompanied with the injection of a sclerosing agent to destroy renal cyst epithelium. Several issues such as the ultimate technique and agent remain to be clarified. High rates of cyst disappearance and long‐lasting cyst volume reduction have been reported with the use of various sclerosants. Ethanol in high concentrations and multiple injections is more commonly used with new agents showing similar efficacy and better complication profile. Studies comparing radiological intervention to surgical excision are lacking. Simple renal cysts may not require treatment when asymptomatic. Radiological intervention with the use of sclerosants needs further evaluation and comparison with other treatment methods.

The Growth of Renal Cysts According to the Exophytic Index of the RENAL Nephrometry Scoring System

“…These studies indicated that neither the actual size nor size changes were specific to the development of a renal neoplasm. The rate of increase in cyst size in patients with renal cancer was similar to that in other patients of the same age [2] . In our review of simple renal cysts, only 5 cysts were excluded as 2 were Bosniak class III renal cysts (1.1%) and 3 were excised because renal tumor was incidentally detected at another site (1.7%).…”

“…Autopsy studies have reported a 50% incidence of renal cysts after the age of 50 years [2] . The prevalence of renal cysts is approximately 10%, ranging from 4% in the third decade to 19% in the sixth decade [3] .…”

“…However, this study also showed decreased growth rate of cysts with increased age. Renal cysts originate from weakened of the tubular basement membrane of the distal convoluted or collecting duct cells [2] . As results, a diverticulum is formed, which can subsequently develop into a simple renal cyst [5,6] .…”

Intraperitoneal marsupialization of a giant para-pelvic renal cyst: A case report

“…7 Recently, percutaneous aspiration of renal cysts along with injection of sclerosing agents (such as alcohol) have been explored as a potential treatment option. 10 This approach of percutaneous management can be effective, especially if the cyst is relatively small and para-pelvic in location; however, if more than 200 mL of the original volume persists after this procedure, then surgery becomes necessary. Retroperitoneal approach for open or laparoscopic surgical decortications is well-established.…”

A General Overview to the Treatment of Cystic Renal Diseases and Innovations in the Treatment: Review

“…Bu nedenle kist boşal-tımı, kist içine sklerozan madde enjeksiyonu (en sık etanol kullanılır) ile birlikte yapılmalıdır. 65 Evre III ve IV lezyonlarda cerrahi eksizyon önerilir. Çünkü bu lezyonlarda malignansi riski sı-rasıyla %59-81,8 ve %100'dür.…”