Ureteric Injury after Image-Guided Ablation of Renal Cell Cancer with Irreversible Electroporation

Ng, Helen; Wang, Kaiwen; Cartledge, Jon; Ralph, Christy; Jagdev, Satinder; Vasudev, Naveen S.; Bhattarai, Selina; Wah, Tze Min

doi:10.1016/j.jvir.2020.09.015

Cited by 3 publications

(1 citation statement)

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“…More recently a ‘pushing-guidewire technique’ [28] was also suggested to efficiently increase the distance of the ureter from the targeted tumour. In the recent years, non-thermal technology with irreversible electroporation (IRE) has been advocated to minimise the thermal injury to ureter [30] , however, in authors’ experience IRE can also lead to ureteric injury if attention has not been made to protect the ureter as described previously [29] . The best prevention, in the authors’ beliefs, is avoidance.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic ureteric stricture post image guided renal cryoablation in a patient with von hippel-lindau syndrome

Chan

Cartledge

et al. 2021

Radiology Case Reports

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A 53-year-old lady is known to have Von Hippel-Lindau syndrome with a long history of previous renal cell carcinomas (RCCs) in both kidneys. She was treated by partial nephrectomy for a right peripheral RCC and subsequently image guided radiofrequency ablation (RFA) of a left central RCC. She developed another de novo RCC adjacent to the right pelvic-ureteric junction (PUJ) 4 years after the initial RFA. Due to the close proximity to the PUJ and visibility of an ice ball with cryoablation (CRYO), the consensus from the MDT was that CRYO would be safer than RFA and she subsequently underwent percutaneous image guided CRYO to treat the small de novo RCC. Unfortunately, during the 1-month imaging follow up, she developed moderate hydronephrosis and a ureteric stricture needing long-term ureteric stent management. This case highlights the risk of ureteric injury caused by the thermal effect of the ice ball during image guided renal CRYO. Therefore, it is vital that all interventional radiologists adopt various manoeuvres to protect the ureter from the ice ball during CRYO in order to avoid the development of latent ureteric stricture.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic ureteric stricture post image guided renal cryoablation in a patient with von hippel-lindau syndrome

Chan

Cartledge

et al. 2021

Radiology Case Reports

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Irreversible electroporation (IRE) in renal cell carcinoma (RCC): a mid-term clinical experience

et al. 2021

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Objectives To evaluate the safety and efficacy of CT-guided IRE of clinical T1a (cT1a) renal tumours close to vital structures and to assess factors that may influence the technical success and early oncological durability. Methods CT-guided IRE (2015–2020) was prospectively evaluated. Patients’ demographics, technical details/success, Clavien-Dindo (CD) classification of complications (I–V) and oncological outcome were collated. Statistical analysis was performed to determine variables associated with complications. The overall 2- and 3-year cancer-specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates are presented using the Kaplan-Meier curves. Results Thirty cT1a RCCs (biopsy-proven/known VHL disease) in 26 patients (age 32–81 years) were treated with IRE. The mean tumour size was 2.5 cm and the median follow-up was 37 months. The primary technical success rate was 73.3%, where 22 RCCs were completely IRE ablated. Seven residual diseases were successfully ablated with cryoablation, achieving an overall technical success rate of 97%. One patient did not have repeat treatment as he died from unexpected stroke at 4-month post-IRE. One patient had CD-III complication with a proximal ureteric injury. Five patients developed > 25% reduction of eGFR immediately post-IRE. All patients have preservation of renal function without the requirement for renal dialysis. The overall 2- and 3-year CS, LRF and MF survival rates are 89%, 96%, 91% and 87%. Conclusion CT-guided IRE in cT1a RCC is safe with acceptable complications. The primary technical success rate was suboptimal due to the early operator’s learning curve, and long-term follow-up is required to validate the IRE oncological durability. Key Points • Irreversible electroporation should only be considered when surgery or image-guided thermal ablation is not an option for small renal cancer. • This non-thermal technique is safe in the treatment of small renal cancer and the primary technical success rate was 73.3%. • This can be used when renal cancer is close to important structure.

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New Developments in Image-Guided Percutaneous Irreversible Electroporation of Solid Tumors

Yun,

Fang,

Khorshidi

et al. 2023

Curr Oncol Rep

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Ureteric Injury after Image-Guided Ablation of Renal Cell Cancer with Irreversible Electroporation

Cited by 3 publications

References 3 publications

Iatrogenic ureteric stricture post image guided renal cryoablation in a patient with von hippel-lindau syndrome

Iatrogenic ureteric stricture post image guided renal cryoablation in a patient with von hippel-lindau syndrome

Irreversible electroporation (IRE) in renal cell carcinoma (RCC): a mid-term clinical experience

New Developments in Image-Guided Percutaneous Irreversible Electroporation of Solid Tumors

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