PD41-12 ACTIVE SURVEILLANCE VS. EMBOLIZATION VS. NEPHRECTOMY: RENAL OUTCOMES IN PATIENTS WITH ANGIOMYOLIPOMAS

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (PD41)1 Sep 2021PD41-12 ACTIVE SURVEILLANCE VS. EMBOLIZATION VS. NEPHRECTOMY: RENAL OUTCOMES IN PATIENTS WITH ANGIOMYOLIPOMAS Silvia Mora, Ithaar Derweesh, Margaret Meagher, Juan Javier-Desloges, Sabrina L. Noyes, and Brian R. Lane Silvia MoraSilvia Mora More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , Sabrina L. NoyesSabrina L. Noyes More articles by this author , and Brian R. LaneBrian R. Lane More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002051.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment for angiomyolipomas (AML) can include active surveillance (AS), embolization, and nephrectomy. Our study investigates renal outcomes of these modalities. METHODS: Two-center (UCSD, Spectrum Health) retrospective analysis of AML patients treated with AS, embolization, or nephrectomy. Demographics and renal function were collected. Primary outcome included renal function, by treatment type, at three timepoints: diagnosis, interim (6-12 months post-diagnosis), and latest. CKD was grouped as 1 (>90), 2a (75-90), 2b (60-75), 3a (45-60), 3b (30-45), 4 (15-30), 5 (<15). RESULTS: 318 patients diagnosed with AMLs were identified with a median follow-up of 3.3 years. 184 (57.9%) underwent AS, 30 (9.4%) underwent embolization, 103 (32.4%) underwent nephrectomy, and 1 (0.3%) underwent radiofrequency ablation. Of the 103 surgical patients, 62 (60.2%) had minimally-invasive partial nephrectomy (PN), 31 (30.1%) had open PN, 3 (2.9%) had laparoscopic radical nephrectomy (RN), and 7 (6.8%) had open RN. Baseline features of AS, embolization, and nephrectomy groups were different in respect to age, sex, and race (p<0.05). The average AML size at diagnosis was 2.1cm for AS, 5.3cm for embolization, and 4.9cm for nephrectomy (p<0.001). When compared to diagnosis GFR, the interim % change in GFR showed a greater decrease for embolization (-14.0%) when compared to AS (-4.1%) and nephrectomy (-11.8%)(p=0.04). Interim CKD stage worsened in AS (26.6%), embolization (26.7%), and nephrectomy (21.4%)(p<0.001). The latest % change in GFR showed a greater decrease for nephrectomy (-14.7%) when compared to AS (-6.6%) and embolization (-14.1%)(p=0.03). Latest CKD stage worsened from diagnosis in AS (42.4%), embolization (53.3%), and nephrectomy (39.8%)(p=0.004). CONCLUSIONS: Reduced renal function is commonly observed over time in AML patients, whether managed conservatively, with embolization, or with surgery. Even so, the majority of AS and surgical patients and slightly less than half of embolization patients had no evidence of worsening CKD stage at latest follow-up. Renal functional surveillance should be obligatory for all AML patients; within the limitations of this retrospective study, surgical intervention appears an appropriate treatment option for selected AML. Source of Funding: Betz Family Endowment for Cancer Research © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e685-e686 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Silvia Mora More articles by this author Ithaar Derweesh More articles by this author Margaret Meagher More articles by this author Juan Javier-Desloges More articles by this author Sabrina L. Noyes More articles by this author Brian R. Lane More articles by this author Expand All Advertisement Loading ...