From the Research
Management of bilateral renal parapelvic cysts typically involves observation with regular monitoring since most are benign and asymptomatic. For asymptomatic patients, follow-up ultrasound or CT imaging every 6-12 months is recommended to monitor for changes in size or characteristics 1. No specific medication regimen is required for uncomplicated parapelvic cysts. Intervention is only necessary when cysts cause symptoms such as flank pain, hematuria, hypertension, or urinary tract obstruction. In symptomatic cases, treatment options include percutaneous aspiration with or without sclerotherapy, laparoscopic or robotic cyst decortication, or open surgical excision depending on cyst size, location, and patient factors 2, 3, 4. Percutaneous aspiration may use sclerosing agents like ethanol (95-99%) or polidocanol (1-3%) to prevent recurrence. Patients should be educated about potential symptoms requiring medical attention, including sudden flank pain, fever, or blood in urine. The conservative approach is justified because parapelvic cysts differ from simple renal cysts in location (adjacent to the renal pelvis rather than in the parenchyma) but share their typically benign nature, with malignant transformation being extremely rare 5. Some key points to consider in the management of bilateral renal parapelvic cysts include:
- Regular monitoring with imaging studies to assess for changes in cyst size or characteristics
- Intervention only when symptoms arise
- Consideration of percutaneous aspiration, sclerotherapy, or surgical excision for symptomatic cysts
- Patient education on recognizing symptoms that require medical attention
- The role of novel techniques such as methylene blue-assisted laparoscopy 2 or percutaneous internal drainage 4 in selected cases. However, the most recent and highest quality study 2 suggests that methylene blue-assisted laparoscopic treatment is a safe, effective, and practical method for the treatment of renal parapelvic cysts, which may be considered in symptomatic cases.