JOURNAL OF ENDOUROLOGY Volume 24, Number 11, November 2010 © Mary Ann Liebert, Inc. Pp. 1883-1886 DOl: 10.1089/end.2010.0223 Contemporary Experience in the Management of Angiomyolipoma i Adam C. Mués, M.D., Jorge Moreno-Palacios, M.D., George Haramis, M.D., Cristin Casazza, B.S., Ketan Badani, M.D., Mantu Gupta, M.D., James McKiernan, M.D., Mitchell C. Benson, M.D., and Jaime Landman, M.D. Abstract Purpose: We review our single center experience in the management of renal angiomyolipoma (AML) in patients who were treated with active surveillance (AS) or invasive treatment protocols. Patients and Methods: A prospectívely evaluated datábase was reviewed, and we identified 91 patients with the diagnosis of renal AML who presented between June 1985 and February 2009. Patient characteristics, clinical presentation, treatment modalities, and paHent outcomes were evaluated. Patients on AS were analyzed for successful completion of the surveillance protocol considering age, symptomatic presentation, and tumor size as potential predictors of invasive treatment. Results: A total of 91 patients with AMLs were identified. The mean patient age was 57 years. Seventy-three (83.9%) patients presented incidentally, and 14 (16%) patients were symptomatic at presentation. Forty-fíve patients were treated with AS, 4 underwent embolization, and 38 patients had extirpative surgery. After a median follow-up of 54.8 months (range 0.2-211.7 mos), there was a mean growth rate of 0.088 cm/year in the group who were treated with AS. AS failed in three patients. Two patients had retroperitoneal bleeding during the observation period, and one patient manifested an expedifious growth rate of 0.7 cm/year and imderwent a radical nephrectomy. Conclusions: A M L is a renal tumor that usually exhibits a benign course. Surgical removal and embolization are the standard invasive treatment modalities. AS for AMLs is associated with a slow and consistent growth rate (0.088 cm/year), typically has minimal morbidity, and is a reasonable option in selected patients. Symptomatic presentation and size (>3 cm) are not predictive for necessitating an invasive procedure. Introduction R ENAL ANGIOMYOLIPOMA (AML) IS a relatively rare renal cortical neoplasm that has been identified in fewer than 0.2% of the general population.' Histologically, AMLs are composed of smooth muscle ceils, dysmorphic blood vessels, and fatty tissue with a known benign natural history. The widespread use of abdominal cross-sectional imaging has increased the incidental detection of all renal masses, includ- ing AMLs.^ As a lesión that is usually asymptomatic, AML is often managed with active surveillance (AS) protocols. The indications for intervenHon include suspicion of malignancy, size greater than 4cm, spontaneous hemorrhage, and pain.' The active treatment of AML includes ultraselective renal embolization, exHrpation, and ablative procedures. We evaluated our single center experience in the manage- ment of renal angiomyolipoma regarding clinical presenta- tion, patient characteristics, and treatment outcomes in an effort to assess the efficacy of contemporary management strategies. Patients and Methods We reviewed our prospectively established datábase and identified the records of 91 patients who had received a di- agnosis of renal A M L between June 1985 and February 2009. The clinical, radiograptiic, and pathologic data were extracted from the complete medical records. The data from patients with a history of tuberous sclerosis complex (TSC) are pre- sented separately in the analysis. Patients who were placed on an AS protocol were observed with annual follow-up imaging using CT or MRI. Tumor size was documented based on the maximal cross-sectíonal di- mensión, and the growth rate was calculated by comparing Department of Urology, Columbia University Medical Center, New York, New York. 1883