Nephron-sparjng surgery for renal angiomyolipoma

Angiomyolipoma (AML) is a benign renal tumor which may require treatment due to associated local complications. The present study was undertaken to evaluate the efficacy of nephron-sparing surgery (NSS) in the management of AML. From July 1980 to May 1996, 22 patients underwent NSS for treatment of renal AML. Two patients had tuberous sclerosis. The clinical presentation, surgical approach and outcome in these patients were analyzed. Surgical treatment for renal AML was indicated due to associated symptoms, size > 4.5 cm or suspicion of renal malignancy. The most common presenting signs or symptoms were pain (23%), hematuria (23%), retroperitoneal hemorrhage or shock (18%), hypertension (5%) and a palpable mass (5%). Thirteen patients had a solitary functioning kidney (Group I), 5 patients had an impaired contralateral (Group II), and 4 patients had a normal contralateral kidney (Group m). NSS was performed for a giant AML in 7 patients (mean tumor size 15.7 cm), including 5 patients with a solitary kidney. All operations were performed in situ in and unique technical aspects of NSS for AML will be reviewed. There were no operative deaths. Three patients developed a postoperative urinary fistula which resolved with non-operative management. All operated kidneys functioned postoperatively and no patient required dialysis. The mean postoperative serum creatinine level in Groups I, II, and III was 1.83 mg/dl, 0.93 mg/dl, and 0.98 mg/dl, respectively. In 5 patients with a giant AML in a solitary kidney, the mean pre and postoperative serum creatiaine level was 1.14 mg/dl and 2.52 mg/dl, respectively. No patients have developed recurrent renal AML or related symptoms. When surgical treatment for renal AML is indicated, NSS can be performed with a high success rate even in patients with a very large tumor involving a solitary kidney.