Renal cryoablation and radio frequency ablation: An evaluation of worst case scenarios in a porcine model

James H. Brashears, Ganesh V. Raj, Alfonso Crisci, Matthew D. Young, Drew Dylewski, Rendon Nelson, John F. Madden, Thomas J. Polascik

Research output: Contribution to journalArticle

67 Scopus citations

Abstract

Purpose: Although ablative technologies, including radio frequency (RF) ablation (RFA) and cryoablation (CA), are being used to treat renal masses, complications associated with injury to vital renal structures are not well understood. We investigated these worst case scenarios by deliberately targeting vital renal structures with CA or RFA in a porcine model. Materials and Methods: Following surgical exposure of the right kidney in female pigs a cryoneedle or an RF probe was deliberately placed under visual and ultrasound guidance in the renal pelvis (CA in 5 pigs and RFA in 7), major calix (CA and RFA in 5 each) or subsegmental renal vessels (CA in 5 pigs and RFA in 7). Cryo-energy or RF energy was then applied to create a 3 cm lesion. After 10 days the kidneys underwent gross and histological examination for urine and blood extravasation, cell death and injury. Ex vivo retrograde pyelography was performed to evaluate for urinary fistulas. Results: All pigs tolerated the treatment and no procedure related deaths occurred. No significant bleeding was noted. RFA and CA created reproducible lesions and areas of cell death and necrosis. Despite significant intentional injury to the collecting system no urinary fistulas were demonstrated in CA specimens (0 of 15). In contrast, damage to the renal pelvis (4 of 7) by dry (3 of 4) or wet (1 of 3) RFA was associated with a high likelihood of urinary extravasation. Conclusions: This short-term study demonstrates that CA is safe, effective and not associated with urinary extravasation. In contrast, RFA to the renal pelvis is associated with urinary extravasation. Further studies are needed to support these findings.

Original languageEnglish (US)
Pages (from-to)2160-2165
Number of pages6
JournalJournal of Urology
Volume173
Issue number6
DOIs
StatePublished - Jun 2005

    Fingerprint

Keywords

  • Catheter ablation
  • Complications
  • Cryosurgery
  • Kidney
  • Swine

ASJC Scopus subject areas

  • Urology

Cite this

Brashears, J. H., Raj, G. V., Crisci, A., Young, M. D., Dylewski, D., Nelson, R., Madden, J. F., & Polascik, T. J. (2005). Renal cryoablation and radio frequency ablation: An evaluation of worst case scenarios in a porcine model. Journal of Urology, 173(6), 2160-2165. https://doi.org/10.1097/01.ju.0000158125.80981.f1