Purpose

To determine safety and efficacy of retrograde pyeloperfusion for ureteral protection during cryoablation of adjacent renal tumors.

Materials and Methods

Retrospective review of 155 patients treated with renal cryoablation, including adjunctive retrograde pyeloperfusion, from 2005 to 2019 was performed. Ice contacted the ureter in 67 of the 155 patients who represented the study cohort. Median patient age was 68 years old (interquartile range [61, 74]), 52 patients (78%) were male, and 37 tumors (55%) were clear cell histology. Mean tumor size was 3.4 ± 1.3 cm, and 42 tumors (63%) were located at the lower pole. Treatment-related complication and oncologic outcomes were recorded based on a review of post-procedural images and chart review.

Results

Technical success of cryoablation was attained in 67 cases (100%), and technical success of pyeloperfusion was attained in 66 cases (99%). A total of 13 patients (19.4%) experienced SIR major C or D complications related to the procedure, including hemorrhage (n = 4), urine leak (n = 3), transient urinary obstruction (n = 2), pulmonary embolism (n = 1), hypertensive urgency (n = 1), acute respiratory failure (n = 1), and ureteropelvic junction (UPJ) stricture (n = 1). No complications were attributable to pyeloperfusion. Three of 45 patients with biopsy-proven renal cell carcinoma experienced local recurrence resulting in local recurrence-free survival of 92% (95% confidence interval, 81.5%–100%) 3 years after ablation.

Conclusions

Retrograde pyeloperfusion of the renal collecting system is a relatively safe and efficacious option for ureteral protection during renal tumor cryoablation. This adjunctive procedure should be considered for patients in whom cryoablation of a renal mass could potentially involve the ureter.

中文翻译：

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肾肿瘤冷冻消融术中逆行肾盂灌注保护输尿管的安全性和有效性。

目的

确定逆行肾盂灌注在相邻肾肿瘤冷冻消融期间保护输尿管的安全性和有效性。

材料和方法

对 2005 年至 2019 年接受肾冷冻消融术（包括辅助逆行肾盂灌注）的 155 名患者进行了回顾性研究。在代表研究队列的 155 名患者中，Ice 接触了 67 名患者的输尿管。患者年龄中位数为 68 岁（四分位距 [61, 74]），52 名患者 (78%) 为男性，37 个肿瘤 (55%) 为透明细胞组织学。平均肿瘤大小为 3.4 ± 1.3 cm，42 个肿瘤 (63%) 位于下极。治疗相关的并发症和肿瘤学结果是根据对术后图像和图表的审查来记录的。

结果

冷冻消融技术成功67例（100%），肾盂灌注技术成功66例（99%）。共有 13 名患者 (19.4%) 经历了与手术相关的 SIR 主要 C 或 D 并发症，包括出血 (n = 4)、漏尿 (n = 3)、一过性尿路梗阻 (n = 2)、肺栓塞 (n = 1)、高血压急迫 (n = 1)、急性呼吸衰竭 (n = 1) 和输尿管盆腔交界处 (UPJ) 狭窄 (n = 1)。没有并发症可归因于肾盂灌注。45 例经活检证实的肾细胞癌患者中有 3 例出现局部复发，消融后 3 年局部无复发生存率为 92%（95% 置信区间，81.5%–100%）。

结论

肾集合系统的逆行肾盂灌注是在肾肿瘤冷冻消融期间保护输尿管的相对安全和有效的选择。对于肾脏肿块的冷冻消融可能涉及输尿管的患者，应考虑这种辅助手术。