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CUAJ – CUA Best Practice Report Guo et al
BPL: AML management

approach may be considered in patients that are hemodynamically unstable despite adequate supportive
44
care.
Acutely hemorrhaging AML in a pregnant woman is an extremely uncommon yet complex
emergency that should be treated by a multidisciplinary team. In a hemodynamically stable patient, with
no sign of fetal distress, conservative management in a monitored setting can be attempted.
Embolization and surgery are both options. In general, embolization offers a less invasive option, but
factors such as fetal distress and maturity may make surgery the preferable option if an emergent C-
section is mandated. 42

Conclusions
Sporadic AMLs are seen and managed by most practicing urologists. The vast majority of these can be
diagnosed radiologically with CT or MRI. While the risk of spontaneous retroperitoneal hemorrhage is
present, this is much lower than originally described. Surveillance is a reasonable option in many of
these cases. Despite the low level of evidence available, the previously prescribed strict 4 cm size cut off
for active intervention management is not supported by evidence in contemporary series. There is no
evidence for the superiority of surgery or embolization for treatment. A proposed management algorithm
is presented in Fig. 2.