2023 UPDATE-Canadian Urological Association guideline: Management of cystic renal lesions

The current guideline summarizes the state-of-the-art knowledge on the management of cystic renal lesions by updating the 2017 Canadian Urological Association (CUA) guideline on the topic. To do so, we updated our search strategy on June 18, 2022, and have identi-fied 38 relevant articles, which led to a revision of the content of the original publication. The panel formulated several recommendations using the GRADE evidence to decision framework - a methodological improvement compared to the previous iteration. Three key recommendation changes were made compared to the previous iteration: 1. Patients with a renal cyst should be classified as per the v2019 Bosniak classification.2. For Bosniak III or IV cyst measuring & LE;2 cm, active surveillance is now suggested as the preferred strategy. 3. For Bosniak III or IV cyst measuring 2-4 cm, active surveillance or surgery are suggested as equal options. The panel made these changes in an attempt to decrease the burden of care for patients, but also acknowledges the low-quality evidence supporting these changes. Consequently, we emphasize the need for shared decision-making. Patients opting for non-surgical strategies should be made aware of the higher uncertainty surrounding the data supporting their treat-ment of choice.