Comparative analysis of the clinical efficacy of three minimally invasive surgical approaches for the treatment of simple renal cysts.

Objective: To compare the clinical efficacy and safety of three minimally invasive surgical approaches-percutaneous aspiration and sclerotherapy (PNA), laparoscopic retroperitoneal decortication (LRD), and percutaneous nephroscopic decortication (PCNL)-in the treatment of simple renal cysts, and to explore the optimal surgical strategy.

Methods: A retrospective analysis was conducted on 90 patients with simple renal cysts treated at our institution between December 2021 and December 2023. Patients were divided into three groups based on the surgical approach received: PNA group, LRD group, and PCNL group, with 30 patients in each. Baseline characteristics (sex, age, cyst location, and size) were collected and compared. Clinical outcomes, including operative time, hospital stay, postoperative drainage volume, time to drain removal, pain scores (VAS at 24 h), perioperative complications, stress markers (hemoglobin, C-reactive protein, procalcitonin, interleukin-6, creatinine), and cure rates, were analyzed among the groups.

Results: There were no statistically significant differences in baseline characteristics among the three groups. The PNA group demonstrated significantly shorter operative time, hospital stay, earlier drain removal, and lower 24-h VAS scores compared with the PCNL and LRD groups (P < 0.05), indicating advantages in minimal invasiveness and rapid recovery. The LRD group achieved the highest cure rate (93.33%) with no recurrence. The PCNL group showed a favorable balance between efficacy and safety. The recurrence rate in the PNA group was 6.67%. Follow-up at 1, 3, 6, and 12 months showed progressive cyst reduction and resolution in all groups, with more stable outcomes observed in the LRD and PCNL groups. The incidence of postoperative complications differed significantly among the three groups (P = 0.046), with the lowest rate in the PNA group (3.33%) and slightly higher in the LRD group (6.67%). Postoperative stress marker changes were smallest in the PNA group, with statistically significant intergroup differences.

Conclusion: All three minimally invasive approaches are safe and effective for the treatment of simple renal cysts. LRD offers the most definitive results with thorough cyst wall excision, making it suitable for larger or anatomically complex cysts. PCNL achieves a favorable balance between efficacy and minimally invasiveness and is appropriate for most posterior renal cysts. PNA is the least invasive, with the fastest recovery, and is more suitable for elderly patients or those with significant comorbidities. Surgical strategy should be individualized based on cyst characteristics and patient factors to optimize outcomes.