In patients with symptomatic PKD who have failed medical management, surgical intervention is a reasonable option, providing long-term pain relief in the majority of patients. Individuals for whom this approach is indicated are usually narcotic dependent or disabled by pain. Cyst decompression surgery does not appear to significantly retard or arrest progressive renal insufficiency. On the other hand, widespread fears that cyst decompression might hasten renal failure are clearly unfounded. The application of newer laparoscopic techniques to this problem may allow for a wider range of symptomatic patients to realize the benefits of cyst decompression.