A 19-year-old boy with tuberous sclerosis is found on CT to have multiple bilateral renal angiomyolipomas; the largest lesion measures 6 cm. He has had one episode of self-limiting haematuria. What is the most appropriate management?
- A Radical nephrectomy of the larger kidney
- B Selective arterial embolisation of the largest lesion ✓
- C Annual surveillance alone irrespective of size
- D Total bilateral nephrectomy with transplant
Correct answer: B. Selective arterial embolisation of the largest lesion
Explanation
Angiomyolipomas larger than 4 cm carry a substantial risk of spontaneous haemorrhage, particularly those with intratumoural aneurysms, and symptoms mandate intervention. Selective transcatheter arterial embolisation is nephron sparing and is the treatment of choice. Radical nephrectomy is avoided in tuberous sclerosis because lesions are multiple and bilateral and renal function must be preserved; surveillance alone is inadequate once the lesion exceeds 4 cm and has bled.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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