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

Publication ,  Journal Article
Brashears, JH; Raj, GV; Crisci, A; Young, MD; Dylewski, D; Nelson, R; Madden, JF; Polascik, TJ
Published in: J Urol
June 2005

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.

Duke Scholars

Published In

J Urol

DOI

ISSN

0022-5347

Publication Date

June 2005

Volume

173

Issue

6

Start / End Page

2160 / 2165

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Fistula
  • Ultrasonography
  • Swine
  • Surgery, Computer-Assisted
  • Renal Artery
  • Necrosis
  • Kidney Pelvis
  • Kidney Calices
  • Kidney
 

Citation

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Brashears, J. H., Raj, G. V., Crisci, A., Young, M. D., Dylewski, D., Nelson, R., … Polascik, T. J. (2005). Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model. J Urol, 173(6), 2160–2165. https://doi.org/10.1097/01.ju.0000158125.80981.f1
Brashears, James H., Ganesh V. Raj, Alfonso Crisci, Matthew D. Young, Drew Dylewski, Rendon Nelson, John F. Madden, and Thomas J. Polascik. “Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model.J Urol 173, no. 6 (June 2005): 2160–65. https://doi.org/10.1097/01.ju.0000158125.80981.f1.
Brashears JH, Raj GV, Crisci A, Young MD, Dylewski D, Nelson R, et al. Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model. J Urol. 2005 Jun;173(6):2160–5.
Brashears, James H., et al. “Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model.J Urol, vol. 173, no. 6, June 2005, pp. 2160–65. Pubmed, doi:10.1097/01.ju.0000158125.80981.f1.
Brashears JH, Raj GV, Crisci A, Young MD, Dylewski D, Nelson R, Madden JF, Polascik TJ. Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model. J Urol. 2005 Jun;173(6):2160–2165.
Journal cover image

Published In

J Urol

DOI

ISSN

0022-5347

Publication Date

June 2005

Volume

173

Issue

6

Start / End Page

2160 / 2165

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Fistula
  • Ultrasonography
  • Swine
  • Surgery, Computer-Assisted
  • Renal Artery
  • Necrosis
  • Kidney Pelvis
  • Kidney Calices
  • Kidney