Systematic Review on Diagnostic Approaches and Management Strategies for Benign Urological Tumors in Adult Populations

Abstract

Background: Benign urological lesions in adults are frequently encountered in clinical practice and include renal angiomyolipoma, benign renal masses, and selected symptomatic benign proliferative conditions managed within urology. Although these lesions are non-malignant, they may still cause hemorrhage, pain, obstructive symptoms, diagnostic uncertainty, and treatment-related loss of organ function. Contemporary management has shifted toward more selective intervention and greater emphasis on nephron preservation, but the evidence remains fragmented across lesion types and treatment pathways. Objective: To systematically evaluate current diagnostic approaches and management strategies for benign urological lesions in adults, with emphasis on diagnostic utility, symptom outcomes, complications, lesion progression, recurrence, and preservation of organ function. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science were searched for studies published between January 2014 and March 2024. Eligible studies included adults with radiologically characterized or histologically confirmed benign urological lesions and reported diagnostic or management outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality using RoB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Results: Eight studies involving 1,427 adults were included. Five studies evaluated renal angiomyolipoma, two examined benign small renal masses, and one assessed symptomatic benign prostatic proliferative disease. Active surveillance was safe for most small asymptomatic angiomyolipomas, with 94% showing no clinically meaningful growth over 36 months in one prospective cohort and 60% of tuberous sclerosis complex-associated cases remaining intervention-free over 5 years. For larger or symptomatic angiomyolipomas, selective arterial embolization preserved renal function better than partial nephrectomy, with a smaller decline in estimated glomerular filtration rate at 12 months (-3.2 vs -11.5 mL/min/1.73 m²; p<0.01), although post-embolization syndrome was more frequent. Percutaneous biopsy for indeterminate small renal masses showed 88% sensitivity, 100% specificity, and a 15% non-diagnostic rate. Conclusion: Current evidence supports surveillance for selected small asymptomatic renal angiomyolipomas and selective arterial embolization as an effective kidney-preserving option for larger or symptomatic lesions. However, the evidence base is predominantly observational and heavily renal-focused, underscoring the need for higher-quality prospective comparative studies across the broader spectrum of benign urological lesions.