Cystic genitourinary lesions in the pelvis: pearls and pitfalls

Cystic lesions of the genitourinary (GU) tract in the pelvis represent a diverse group of entities that can be challenging to characterize due to overlapping anatomy and variable imaging appearances. While most lesions are benign, accurate identification is critical to guide appropriate clinical management and avoid misdiagnosis. This review presents a comprehensive, image-rich overview of cystic pelvic lesions, focusing on the anterior and middle compartments in both male and female patients. Imaging modalities such as ultrasound, CT, and MRI each provide distinct advantages depending on the clinical context and lesion characteristics. Key entities include bladder, urethral, and ureteral diverticula; urachal anomalies; prostatic utricle and Müllerian duct cysts; seminal vesicle and ejaculatory duct cysts; Gartner duct and Bartholin gland cysts; and infectious processes. Less common pathologies, such as lymphangiomas, benign cystic tumors, and mimics of cystic lesions, including bulking agents, hydrogel spacers, hernias, and cystic degeneration of solid tumors, are also addressed. This manuscript offers practical pearls and highlights potential pitfalls in the evaluation of cystic GU lesions. Familiarity with typical imaging features and potential mimics is essential to ensure diagnostic accuracy and improve patient outcomes.