Objective <p>To compare the clinical outcomes of ultrasonography-guided aspiration and sclerotherapy and laparoscopic deroofing for the treatment of simple renal cysts in children, providing evidence for clinical decision-making in the management of pediatric renal cysts.</p> Methods <p>A total of 49 patients with simple renal cysts were divided into two groups based on the treatment method: 29 patients (group 1) underwent laparoscopic deroofing, 20 patients (group 2) underwent ultrasonography-guided aspiration and sclerotherapy. The clinical efficacy differences between the two groups were compared. During the study period, optimizations were made to the aspiration and sclerotherapy procedure in terms of sclerosant injection volume, sclerosing time, frequency, and intervals.</p> Results <p>The complete disappearance rate of cysts in group 2(95.0%) was significantly higher than that in group 1 (33.3%) (<i>P</i> &lt; 0.001). The recurrence rate of cysts in group 2 was 0%, significantly lower than that in group 1 (33.3%) (<i>P</i> = 0.014). The group 2 had shorter hospital duration, indwelling catheterization duration, indwelling drainage duration, intraoperative blood loss, and operative time compared to the group 1 (<i>P</i> &lt; 0.001). No severe complications such as intra-abdominal organ injury occurred in either group. However, in the group 2, 6 cases experienced transient low back pain and/or "alcoholic reaction", which resolved spontaneously.</p> Conclusion <p>Compared to laparoscopic deroofing, aspiration and sclerotherapy for simple renal cysts in children demonstrates a higher complete disappearance rate. It is an economical, minimally invasive, and effective treatment option. The modified aspiration and sclerotherapy in this study showed good clinical outcomes and is worthy of further promotion.</p>