Báo cáo y học: Cold saline irrigation of the renal pelvis during Radiofrequency Ablation of a central renal neoplasm: a case report

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Báo cáo y học: "Cold saline irrigation of the renal pelvis during Radiofrequency Ablation of a central renal neoplasm: a case report"Journal of Medical Case Reports BioMed Central Open AccessCase reportCold saline irrigation of the renal pelvis during RadiofrequencyAblation of a central renal neoplasm: a case reportJose P Morales1, Tarun Sabharwal*1, Marios Georganas1, Renato Dourado1,Declan Cahill2 and Andreas Adam1Address: 1Department of Interventional Radiology, Guys and St Thomas Foundation Hospital NHS Trust, London, UK and 2Department ofUrology, Guys and St Thomas Foundation Hospital NHS Trust, London, UKEmail: Jose P Morales - jpmorales@doctors.org.uk; Tarun Sabharwal* - Tarun.Sabharwal@gstt.nhs.uk;Marios Georganas - gmarios@doctors.org.uk; Renato Dourado - Renato.Dourado@gstt.nhs.uk; Declan Cahill - Declan.Cahill@gstt.nhs.uk;Andreas Adam - Andy.Adam@kcl.ac.uk* Corresponding authorPublished: 7 February 2008 Received: 21 March 2007 Accepted: 7 February 2008Journal of Medical Case Reports 2008, 2:40 doi:10.1186/1752-1947-2-40This article is available from: http://www.jmedicalcasereports.com/content/2/1/40© 2008 Morales et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction: Thermal destruction mediated by radiofrequency ablation (RFA) is gaining attention as an alternative treatment for patients with renal cell carcinoma (RCC), particularly in those who are not candidates for open surgery. Treatment of central tumours is occasionally associated with complications such as ureteric stricture, injury to the psoas muscle, haematuria and vascular laceration. Case presentation: We have used infusion of cold saline during RFA, through a retrograde ureteric catheter with its tip in the renal pelvis, in a patient with a central renal tumour. Conclusion: We believe this process to have successfully avoided the risk of thermal injury.Introduction Case presentationThermal destruction mediated by radiofrequency ablation A 62-year-old woman who had an incidental finding on(RFA) is gaining attention as an alternative treatment for computed tomography (CT) of a right renal mass waspatients with renal cell carcinoma (RCC), particularly in referred to our unit for RFA. The CT appearance of thethose who are not candidates for open surgery [1]. RFA tumor, which 3.2 × 3.2 × 3.8 cm, were consistent with (butcarries less risk in the treatment of peripheral RCC. Treat- not diagnostic of) primary RCC. Its medial margin wasment of centrally located tumours is occasionally associ- immediately adjacent to the renal pelvis (Fig 1). At theated with complications such as ureteric stricture, injury time of diagnosis the left kidney was atrophic. There wasto the psoas muscle, haematuria and vascular laceration no evidence of metastases. The patient had been previ-[2]. However, protective measures can be taken to increase ously evaluated by a urologist expert in partial nephrec-the safety of RFA when the electrode is located near the tomy. However, given the size and location of the mass,hilum of the kidney. We have used infusion of cold saline and the fact that the contra-lateral kidney was atrophic,during RFA, through a retrograde ureteric catheter with its surgery was considered inappropriate following discus-tip in the renal pelvis, in a patient with a central renal sion at two consecutive multidisciplinary meetings at thetumour in order to reduce the risk of thermal injury. referring hospital. The alternative of RFA with simultane- ous cold saline irrigation of the renal pelvis was discussed ...