Treatment options for renal peri-hilar cysts

INTRODUCTION: No uniformity exists in diagnosing and treating benign cysts located at or around the renal hilum. Parapelvic or peripelvic cysts are described as being both simple parenchymal cysts in a near hilar location, and renal sinus cysts with no parenchymal derivation. Regardless of their etiology, these cysts can cause symptoms secondary to obstruction, hemorrhage, infection, and stone formation. In this paper we report our series of 5 patients treated for such cysts using four different therapeutic alternatives. METHODS: Five patients (mean age 57) were treated for symptomatic perihilar renal cysts since 1991. Four patients presented with flank pain secondary to obstructive uropathy and one patient had recurrent abscess formation of her cyst. Therapeutic approaches included: percutaneous drainage, endoscopy, biopsy and fulguration of the cyst (2 patients); cyst aspiration and sclerosis with ethanol (1 patient); laparoscopic extraperitoneal unroofing of the cyst (1 patient); and open cyst marsupialization (1 patient). RESULTS: All 5 patients reported relief of symptoms and all had radiographie evidence supporting no cyst reaccumulation with follow-up of 2 to 68 months (mean 23 months). Three patients have been followed for less than one year. CONCLUSION: Although only a minimum proportion of these cysts require definitive treatment, various effective treatment options do exist. For large perihilar cysts located anteriorly, we recommend a laparoscopic approach. Posterior cysts are more easily treated with percutaneous drainage and fulguration if large, and sclerotherapy if small. Open surgery is reserved for exceptional circumstances, such as prior treatment failure or need to rule out underlying malignancy. With endourologic skills and these guidelines we believe that most sympomatic perihilar cysts can be properly managed endoscopically.