Protection of the Renal Collecting System during Radiofrequency Ablation with Antegrade Cold Dextrose Infusion

Abstract

RF ablation after placement of an antegrade cooling system in pig kidneys was feasible. Antegrade cold dextrose infusion of the urinary tract during RF ablation is effective in protecting the renal collecting system without compromising the RF ablation effect.

Analysis of the effect of renal excretory system cooling during thermal radiofrequency ablation in an animal model

“…Also, the exposition of the needle was smaller in the present study (1cm) in relation to previous ones (3cm) (20) and intentionally was not place upon the excretory tract (7). So our results are related to lesions close to the urothelium and further studies are needed for more profound lesions with bigger damage to the urothelium and to test the consequences of cooling.…”

“…Main limitations of our study are the absence of median and long terms data and not use of an oncological model, as occurred with other studies (4,7,20) as well as the low exposition of the needle (1cm) avoiding lesion of the excretory tract, although the clinical significance of the lesions is questionable (4,7,20).…”

“…Some aspects differentiate our study: the use of in vivo retrograde pyelogram (most studies used ex vivo (20)), lower morbidity of retrograde cooling in relation to antegrade (that requires nephrostomy), avoiding dissemination, bleeding and additional trauma (20), use of hystopathology to measure the lesion, ablation under direct vision and use of intrasurgical ultrasound in order to maximize accuracy of ablation, data collection and hystological interpretation without knowledge of cooling, avoiding bias and the use of saline in order to avoid complications in the event of leakage and absorption.…”

Solid renal masses: effectiveness and safety of image-guided percutaneous radiofrequency ablation

“…Percutaneous RFA of central and lower pole renal masses is associated with a risk for thermal injury to the collecting system or ureter, which may result in development of a delayed stricture or urine leak. For tumors lying in close approximation to the collecting system or ureter at the level of the renal pelvis, pyeloperfusion has been described as an effective technique for avoiding thermal injury to the collecting system [46][47][48]. This consists of cystoscopic placement of a retrograde ureteral stent, through which cold saline is continuously infused during the process of RF heating.…”

Efficacy of Antegrade Pyeloperfusion to Protect the Renal Pelvis in Kidney Microwave Ablation Using an In Vivo Swine Model

“…9,10 For RFA, a number of protective measures have been established, such as antegrade or retrograde pyeloperfusion, which has been shown to be effective in protecting the renal pyelon while allowing treatment of adjacent central tumors. 11,12 However, for MWA, to the best of our knowledge, no such protective measures have been established, although the more efficient heat propagation in MWA compared with RFA would make such protection even more important.…”