Nephron Sparing Surgery for Large Renal Angiomyolipoma: A Case-Series and Literature Review

Introduction:Renal angio/myo/lipoma (AML) is a benign mesenchymal tumor with high bleeding potential and minimal risk of malignant transformation.Larger size masses can lead to serious medical conditions.Treatment usually varies from case to case ranging from minimally invasive approaches to surgical interventions.Objective and Methodology:The aim of this study is to endorse nephron-sparing surgery as an effective treatment option for large renal angiomyolipoma in facilities where intervention radiology is not readily available.In our manuscript we present a series of two cases of AML (above 8cm) treated surgically with open partial nephrectomy, attempting to achieve a shorter vascular exclusion time.Results: Large AMLs may pose challenges in management, with a focus on preserving renal function, using the minimally invasive approaches and minimizing the risk of life-threatening hemorrhage.Our case-series of nephron-sparing surgery (NSS) attaining short warm and cold ischemia times demonstrated a good outcome with acceptable complications.Both patients had an uneventful early postoperative course with normal creatinine and were discharged a few days after surgery.Only one patient had a late complication at two months, manifested by urinoma, which was managed with ureteral double-J stenting and percutaneous drain insertion.Otherwise, two years follow-up showed no abnormal laboratory or radiologic findings.Conclusion: Management of large renal angiomyolipomas can be challenging especially in places where embolization is not feasible and robot-laparoscopic modalities are not available.Therefore, open nephron-sparing surgery can be indicated as a safe and valid therapeutic choice with desirable outcomes.