Right renal autotransplantation as a kidney-sparing strategy in complex symptomatic angiomyolipoma

We present the case of a 34-year-old male with right flank pain. Computed tomography revealed at least six cortical, expansible, fat-density lesions in the right kidney and two similar lesions in the left kidney, consistent with angiomyolipomas. Surgical management consisted of radical right nephrectomy with immediate renal autotransplantation. Ex vivo tumour excision was performed under ultrasound guidance and hydrodissection, followed by cortical reconstruction and reimplantation into the ipsilateral iliac fossa. Vascular anastomoses were fashioned end-to-side to the external iliac vessels, and ureteral reimplantation was achieved using the Taguchi technique with double-J stent placement. The postoperative course was uneventful, with preserved renal function. This case highlights the value of multidisciplinary assessment, individualized planning, and meticulous surgical technique to avoid unnecessary radical nephrectomy, particularly in patients with bilateral renal tumors.