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Pyeloperfusion as a Protective Mechanism for Radiofrequency Ablation of Renal Carcinoma Contiguous to the Ureter: Technique, Results and Complications
Jairam R Eswara1, Debra Gervais1, Peter Mueller1, Ron Arellano1, Colin Cantwell2, Raul Uppot1, Francis McGovern1
1Massachusetts General Hospital, Boston, MA;2St. Vincents, Dublin, Ireland
Introduction:Radiofrequency-ablation (RFA) is an effective means of renal tumor ablation. Ablation of masses adjacent to the ureter risks ureteral injury/stricture. Placement of a ureteral catheter and pyeloperfusion with dextrose 5% in water (D5W) has been used as a method of reducing the risk of ureteral injury/stricture.
Materials & Methods: Between November 2005 and July 2010, 46 patients (52 ablations) required pyeloperfusion to protect the ureter. Patients were selected for retrograde-pyeloperfusion during RFA if the tumor was located within 1.5cm of the ureter. Pyeloperfusion was performed via a 5 Fr ureteral catheter and retrograde instillation of D5W. Tumors were classified as central, exophytic, or mixed according to the Gervais classification system. All procedures were performed under CT-guidance.
Results: 52 RFAs with pyeloperfusion were performed with an 87% success rate. Median tumor diameter was 3.3 cm. 14/45 (31%) patients had major complications according to the Society of Interventional Radiology classification, but 2 patients (4%) developed a ureteral stricture managed with stenting. 5 patients (10%) had significant hematuria, 2 (4%) had urinomas requiring IR-drainage, and 1 had pseudoaneurysm requiring angioembolization. 2 patients (4%) had delayed abscesses: 1 patient underwent IR-drainage of the abscess, 1 underwent nephrectomy for possible recurrent tumor, but was found to be an abscess with no evidence of malignancy.
Conclusions: RFA for renal masses is well-tolerated. Pyeloperfusion for ablations adjacent to the ureter led to only 2 ureteral strictures but also 2 delayed abscesses. Our rate of complications is slightly higher than that of other contemporary RFA series.
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