Canadian Urological Association Best Practice Report: Diagnosis and management of sporadic angiomyolipomas

Guo, Yanbo; Kapoor, Anil; Cheon, Paul; So, Alan; Lattouf, Jean‐Baptiste; Jamal, Munir

doi:10.5489/cuaj.6942

Cited by 7 publications

(9 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Neither the most recent Canadian nor European Urology Association guidelines recommend a specific size threshold for treatment. [8,10] In our series, emergency cases receiving SAE had a mean diameter of 12.3cm and the smallest tumour by diameter was 4.7cm, with the remainder greater than 9cm .This was similar for patients with pre-intervention evidence of retroperitoneal haemorrhage. Our study is not designed or powered to make statements on elective thresholds for treatment.…”

Section: Discussionsupporting

confidence: 58%

“…The lack of prospective, randomized studies in the management of AMLs and the significant heterogeneity in the available retrospective evidence presents a challenge in many aspects of their clinical management. [10] Current evidence shows that the chance of becoming symptomatic from an AML increases significantly with size greater than 4cm or growth rate greater than 0.25cm/year. The traditional cut-off has been 4cm before intervention, however some now recommend not intervening until size is greater than 6cm.…”

Section: Discussionmentioning

confidence: 98%

“…They recommend discussion of elective treatment in AMLs >4cm. [10] Other factors must be taken into account as well, including aneurysmal component, pregnancy, coagulopathy, trauma, hormone level and co-morbidity with TSC. [11] The duration, imagining modality and which AMLs to follow up has no clear guidance.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Single-institution retrospective review of elective and emergency embolization of renal angiomyolipoma

Chapman¹,

Tyson²,

Buckley³

2021

CUAJ

View full text Add to dashboard Cite

Introduction: We aimed to evaluate the size reduction and complications after transcatheter embolization of renal angiomyolipomas (AMLs). Methods: Cases from a single tertiary center were analyzed retrospectively. A blinded radiologist provided measurements of AMLs using a combination of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Electronic clinical notes, radiographic imaging, and laboratory data were reviewed. Results: Twenty-one embolization procedures from 2002–2019 were analyzed. Four cases were emergency, the remainder elective. The average followup time after intervention was 42 months. Techniques included ethanol, PVA, Gelfoam, Embospheres®, Histacryl®, and coils. The median diameter size of AMLs was 8.6 cm pre-procedure and 6.0 cm post-procedure. The median volume of AMLs was 200 cc pre-procedure and 67 cc post-procedure, with a median reduction in volume of 55%. One case (4.8%) had a re-embolization and three cases (14.3%) proceeded with surgical management of the AML. No cases re-presented with bleeding. Post-embolization syndrome is common. Renal arterial dissection and renal abscess are infrequent complications (9% and 4.5%, respectively). There was no treatment-based mortality. Conclusions: Embolization for renal AMLs is an established, safe, and effective method of treatment and our series further supports that. Determining when to intervene and how long to follow up patients is an issue that has not been well-described; more research needs to be done in this area.

show abstract

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Single-institution retrospective review of elective and emergency embolization of renal angiomyolipoma

Chapman¹,

Tyson²,

Buckley³

2021

CUAJ

View full text Add to dashboard Cite

show abstract

“…The natural history of rAML is controversial and varies between studies. The clinical course has been correlated with age at presentation, blood group, and location of tumor ( 13 – 15 ). The correlation between the size of tumors and growth is controversial.…”

Section: Epidemiology Pathogenesis and Natural Coursementioning

confidence: 99%

“…The choice to switch from surveillance to start treatment depends on the presence of symptoms as well as tumor size (>4–6 cm is an accepted cut-off, although controversial) ( 13 ). Treatment options include surgery and embolization of blood vessels.…”

Section: Management Of Raml: Different Scenarios and Latest Developmentsmentioning

confidence: 99%

Spectrum of Presentations and Management Strategies in Renal Angiomyolipoma

Khaddam

Gulati

2022

jkcvhl

View full text Add to dashboard Cite

Renal angiomyolipoma (rAML) occurs rarely sporadically but is commonly encountered in patients with tuberous sclerosis complex and lymph-angioleiomyomatosis. rAML is a rare entity, not seen regularly in daily practice; however, is commonly encountered and diagnosed by clinicians who approach and treat kidney masses. Basic knowledge of this entity is necessary to recognize that despite being benign, these tumors can rarely cause deadly complications such as hemorrhage or severe renal dysfunction or may have malignant components associated with them.

show abstract

Renal angiomyolipoma selective arterial embolization: Australian tertiary centre experience over 10 years

Siasat,

Griffin,

Jhamb

et al. 2024

J Med Imag Rad Onc

View full text Add to dashboard Cite

IntroductionThe purpose of this study is to evaluate the patient selection methods, treatment outcomes, complications, clinical and radiological follow‐up after renal angiomyolipoma (AML) treatment with selective arterial embolization (SAE) in an Australian metropolitan tertiary centre.MethodsThis study presents a retrospective single‐centre review of patients' medical records who underwent SAE for renal AML during the period of 1st January 2012 and 1st January 2023.ResultsA total of 32 SAE procedures for renal AML occurred during the study period. Three episodes were classified as emergency cases [9.38%] and the remaining 29 were treated electively. Mean AML size pre‐treatment was 69.45 mm (range = 33–177; SD = 31.69). All AMLs demonstrated hyper‐vascularity on contrast‐enhanced cross‐sectional imaging (arterial‐phase enhancement characteristics and/or prominent tortuous feeding vessels) [n = 32; 100%] or an intralesional aneurysm or pseudoaneurysm [n = 12; 42.85%]. Periprocedural complications [n = 3; 9.38%] included: one intralesional haemorrhage after embolization, one vascular access site complication, and one lipiduria‐associated urinary tract infection. No patients suffered a life‐threatening complication, non‐target embolization, deterioration in renal function or death following SAE. Re‐treatment with SAE was performed in only three patients [10.71%]. Hospital mean length of stay was 1.58 days. Median durations of clinical and radiological follow‐up post‐treatment were 493 days (range = 104–1645) and 501 days (range = 35–1774), respectively. Follow‐up imaging revealed AML total size reduction in all cases [mean = −17.17 mm; −26.51%] and 50% had obliteration of lesion hyper‐vascularity after one episode of SAE. Outpatient clinical follow‐up signifies that none of the patients included in the study have re‐presented with lesion haemorrhage after successful SAE.ConclusionIn this study, renal AMLs were treated safely with a high degree of success by using SAE, and there were very low rates of periprocedural complications. Follow‐up of patients after SAE treatment of renal AML should include both radiological (assessment for reduction in lesion vascularity and size) and clinical review in an outpatient clinic setting (either by an interventional radiologist or urologist).

show abstract

Canadian Urological Association Best Practice Report: Diagnosis and management of sporadic angiomyolipomas

Cited by 7 publications

References 70 publications

Single-institution retrospective review of elective and emergency embolization of renal angiomyolipoma

Single-institution retrospective review of elective and emergency embolization of renal angiomyolipoma

Spectrum of Presentations and Management Strategies in Renal Angiomyolipoma

Renal angiomyolipoma selective arterial embolization: Australian tertiary centre experience over 10 years

Contact Info

Product

Resources

About