From the Guidelines
The management approach for renal cysts with minimal septations is primarily conservative with regular surveillance imaging, as most of these cysts are benign and have a low risk of malignancy, approximately 0% for Bosniak I and II cysts 1.
Key Considerations
- Most renal cysts with minimal septations are classified as Bosniak category II, which requires no intervention beyond periodic monitoring with ultrasound or CT scans every 6-12 months initially, with the possibility of extending intervals if stability is demonstrated 1.
- The Bosniak classification system, updated in 2019, is used to predict the risk of malignancy and guide management for renal cystic masses, with Bosniak I, II, IIF, III, and IV cysts having approximately 0%, 0%, 10%, 50%, and 100% malignancy rates, respectively, in surgically treated cases 1.
- Concerning features such as increasing septations, wall thickening, nodularity, or calcifications may upgrade the cyst to a higher Bosniak category, necessitating more frequent monitoring or intervention 1.
- Symptomatic cysts causing pain, hypertension, or obstruction may require percutaneous aspiration, sclerotherapy, or surgical excision regardless of their Bosniak classification.
Surveillance and Follow-Up
- Regular surveillance imaging is crucial for monitoring the size and characteristics of the cyst, with adjustments to the follow-up schedule based on the presence of concerning features or changes in the cyst's appearance 1.
- Patients should be educated about the benign nature of these lesions and the importance of adhering to recommended follow-up schedules to ensure early detection of any potential changes or complications.
Intervention
- Intervention is typically reserved for cysts with suspicious features or those causing symptoms, as the risks associated with unnecessary interventions, such as bleeding, infection, and renal damage, outweigh the benefits for most minimally septated cysts 1.
From the Research
Management Approach for Renal Cysts with Minimal Septations
The management of renal cysts with minimal septations involves radiographic surveillance to monitor the size and characteristics of the cysts.
- The study 2 found that radiographic surveillance is an effective method for managing patients with minimally or moderately complex renal cysts, allowing for the identification and removal of malignant lesions while avoiding surgery in most patients.
- The size and characteristics of the cysts are monitored over time, with changes in size or characteristics prompting further evaluation or surgical intervention.
Monitoring and Follow-up
Regular follow-up is necessary to monitor the size and characteristics of the cysts, with the frequency of follow-up depending on the size and complexity of the cysts.
- The study 2 found that the size of the cysts increased in 29 patients, decreased in 14, and remained unchanged in 7, with the cyst character worsening in 7 patients, improving in 4, and remaining unchanged in 39.
- The study 3 recommends follow-up for simple renal cysts with slightly irregular shapes to exclude malignant progression.
Treatment Options
Treatment options for symptomatic renal cysts include aspiration with sclerotherapy and laparoscopic deroofing.
- The study 4 found that aspiration-sclerotherapy is a safe and effective first-line therapy for symptomatic simple renal cysts, with a treatment success rate of 87.7%.
- The study 5 compared aspiration with sclerotherapy and laparoscopic deroofing, finding that laparoscopic deroofing was associated with higher symptomatic and radiological success rates, but also higher complication rates and costs.
- The study 6 found that ethanol sclerotherapy was highly effective in treating symptomatic simple renal cysts, with complete cyst ablation in 54 cysts and partial resolution in 10, and no major complications.