Current Insights into Pathophysiology, Clinical Presentation, and Minimally Invasive Management of Renal Peripelvic Cysts, A Narrative Review

Document Type : Review Article

Authors

1 Department of General Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

2 Department of Urology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

3 Trauma Research Center, Aja University of Medical Sciences, Tehran, Iran Assistant professor of Pediatrics Department, Aja University of Medical Sciences

4 Assistant Professor, Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

5 Student Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

Abstract
Background: Renal peripelvic (parapelvic) cysts cause hydronephrosis, pain, and obstruction when exceeding 4-5 cm due to hilar compression, with elevated IL-6, TNF-α, and creatinine reflecting inflammation and impaired function.​
Objective: This narrative review synthesizes evidence on pathophysiology, diagnosis, and minimally invasive management, emphasizing retroperitoneoscopic decortication versus ureteroscopic drainage outcomes.​
Methods: Literature from 2011-2025 (PubMed, Scopus, Web of Science) was reviewed, prioritizing comparative studies, case series (n≥20), and biomarker data; a key 100-patient cohort provided head-to-head analysis.​
Results: Retroperitoneoscopic decortication shows superior outcomes versus ureteroscopy: shorter operative time (78±18 vs 112±24 min), less blood loss (25±15 vs 55±30 mL), faster recovery (hospital stay 2.8±0.9 vs 5.1±1.4 days), lower complications (8% vs 18%), and greater IL-6/TNF-α decline; recurrence rates similar (8-10%).​
Conclusion: Retroperitoneoscopic decortication is optimal for symptomatic peripelvic cysts, balancing efficacy, safety, and biomarker recovery over ureteroscopy

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