Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization

BACKGROUND: Angiomyolipoma (AML) is a benign renal neoplasm. First-line therapy includes renal preserving surgery or angioembolization (RAE), both with good outcomes in isolated studies. However, there are no comparative randomized trials and no clinical guidelines to help clinicians decide between these treatment modalities. Our study examines the patterns of AML treatment at a tertiary care centre to evaluate how local urologists have been treating this disease. METHODS: This is a retrospective study of all AMLs treated at the Vancouver General Hospital (Vancouver, BC, Canada) over the past 10 years with either RAE or surgical excision. Searches were performed of the radiology and pathology dictation systems, using the following keywords: AML, angiomyolipoma, angioembolization, embolization, surgery, partial nephrectomy and nephrectomy. RESULTS: At our institution, more AMLs were treated by surgery than angioembolization (42 vs. 17 cases). Angioembolization was more often chosen for cases of multifocal AML (35% vs. 7%) and acute hemorrhage (50% vs. 14%). In the angioembolization cases, particles were the embolic agent of choice (used 40% of the time). CONCLUSIONS: Angioembolization allows rapid patient stabilization in cases of acute hemorrhage, and provides good renal preservation in cases of multifocal AML. It may also be preferred in large masses when partial nephrectomy is not feasible. Surgery should be performed in cases of diagnostic uncertainty or complex vascular anatomy not amenable to RAE. Prospective randomized studies are needed to compare RAE and surgery to better define their indications in sporadic AML.