Percutaneous nephrolithotomy with renal angiomyolipomas: a rare challenge

Area of Science:

• Urology
• Nephrology
• Interventional Radiology

Background:

• Renal angiomyolipomas (AML) are vascular tumors that carry a risk of bleeding.
• Renal trauma can also cause hemorrhage, complicating procedures.
• Patients with tuberous sclerosis often present with bilateral renal AMLs.

Observation:

• A case of a 21-year-old male with tuberous sclerosis, obesity, and mental retardation presenting with a staghorn calculus and extensive bilateral renal AMLs.
• Initial avoidance of direct renal puncture due to AMLs, followed by successful direct puncture through AMLs for percutaneous nephrolithotomy.
• Nephrostomy access was created under 3D CT guidance, and a second access site through an AML was established using standard fluoroscopy.

Findings:

• Three-dimensional CT imaging enabled accurate renal access.
• Fluoroscopically guided renal access and dilation to 34F through an AML were performed without clinically significant bleeding.
• The patient experienced an uneventful recovery with no postoperative retroperitoneal collection.

Implications:

• Renal access can be safely achieved in patients with extensive renal angiomyolipomas using advanced imaging and fluoroscopic guidance.
• Percutaneous nephrolithotomy is a viable option for stone removal in patients with complex renal masses.
• This case highlights the safety and efficacy of direct renal access through AMLs, challenging previous concerns about bleeding risk.