To analyze and present the demography, clinical behavior, especially the risk factors of tumor hemorrhage and management of sporadic angiomyolipoma (SAML), tuberous sclerosis complex associated angiomyolipoma (TSCAML) and epithelioid angiomyolipoma (EAML) in our institution. A retrospective study of 587 patients who were diagnosed with renal angiomyolipoma in our institution between January 2000 and May 2015 was done. The AMLs were diagnosed by ultrasonography, CT, or MRI. EAML was confirmed by histopathology. Medical records and follow-up results were analyzed using the SPSS version 22 software. Out of 587 cases of renal AMLs, 87.4% were SAMLs, 8.7% were TSCAMLs and 3.9% were EAMLs. Most of the AML patients were asymptomatic. The most common presenting symptoms included flank pain and abdominal pain. The median tumor size of SAML, TSCAML, EAML were 4.7, 2.7, 10.5 cm respectively. Approximately half of SAMLs were conservatively treated, almost all TSCAMLs were treated conservatively, while all EAMLs were surgically treated. The median tumor size of hemorrhagic SAML cases was 8 cm versus non-hemorrhagic cases of 4.1 cm. The optimal cut-off point on the ROC curve for predicting SAML tumor hemorrhage was 7.35 cm. A larger tumor size, younger patient's age and higher BMI value correlated with a higher risk of tumor hemorrhage. For tumor sizes less than 7.35 cm, we recommend active surveillance or TAE for hemorrhage prevention. We also suggest that surgical management should be considered for patients with tumors larger than 7.35 cm, symptomatic and progressive AML, or suspicious EAML.

Background and Objectives: Benign prostatic hyperplasia is a common condition among aging men, leading to bladder outlet obstruction and associated lower urinary tract symptoms. Surgical intervention, particularly endoscopic enucleation of the prostate, has become increasingly popular over traditional methods such as transurethral resection of the prostate. However, urethral strictures remain a major postoperative complication. This study evaluated the incidence, risk factors, and clinical outcomes of urethral strictures after endoscopic enucleation of the prostate. Materials and Methods: This study retrospectively analyzed prospectively collected data from 246 patients who underwent either thulium laser enucleation of the prostate or bipolar transurethral enucleation of the prostate at Chang Gung Memorial Hospital between October 2018 and December 2022. Patients were evaluated preoperatively using uroflowmetry, International Prostate Symptom Score (IPSS), and other relevant clinical metrics. Follow-up assessments at 2 weeks, 3 months, and 6 months post-surgery included uroflowmetry, IPSS evaluation, and cystoscopy when indicated. A urethral stricture was deemed to be present if a 5.5 mm fiber cystoscope was unable to pass through the urethra. Results: Of the 246 patients, 23 (9.3%) developed urethral strictures, with the membranous urethra being the most common site (69.2%). Patients with strictures had significantly smaller prostate volumes and enucleated tissue weights, higher trial without catheter (TWOC) failure rates, and a higher postoperative urinary tract infection (UTI) incidence. Multivariate analysis identified smaller prostate size, lower resected tissue weight, TWOC failure, and postoperative UTI as significant risk factors for stricture formation. The type of energy source used for enucleation (bipolar or Thulium laser) was not identified as a factor influencing the incidence of urethral stricture. Conclusions: Urethral strictures constitute a major complication following endoscopic enucleation of the prostate, particularly in patients with smaller prostates and those experiencing postoperative complications such as UTIs and TWOC failure. These findings underscore the importance of careful surgical technique and rigorous postoperative monitoring to reduce the incidence of this complication.

Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.