TY - JOUR
T1 - Renal cryoablation - does deep endophytic ablation affect the renal collecting system?
AU - Makki, Ahmad
AU - Aastrup, Malene B.
AU - Vinter, Hanne
AU - Ginnerup, Bodil
AU - Graumann, Ole
AU - Borre, Michael
AU - Nielsen, Tommy Kjaergaard
PY - 2020/1/2
Y1 - 2020/1/2
N2 - Objective: To investigate to what extent the urothelium of the renal collecting system is affected when performing deep endophytic cryoablation. Methods: The study was conducted as an in vivo animal model with a total of 15 female pigs. Each animal was subjected to bilateral endophytioc renal cryoablation and randomized to a postoperative follow-up period of either one, two or four weeks. At the end of follow-up all animals had a magnetic resonance imaging (MRI) examination and bilateral nephrectomy was performed. On MRI-imaging the extent of the cryolesions, as well as signs of urinomas or fistulas, were examined. Histopathologic examinations were performed to investigate the effect on the urothelium. Results: All animals tolerated the procedure well without any postoperative complications. MRI examinations found the renal collecting system to be involved in the cryolesions at all three stages of follow-up and revealed no signs of hematomas, urinomas or fistula formations. Epithelial edema was found at all three stages of follow-up while significant parenchymal fibrosis adjacent to the urothelium was most pronounced in the four weeks of follow-up group. The urothelium was significantly affected with luminal hemorrhage as well as hemorrhage in and underneath the urothelium and urothelial dissociation from the underlying renal parenchyma. Despite these impacts on the urothelium, this was found to be intact and vital at all three stages of follow-up, in sharp contrast to the renal parenchyma that underwent fibrotic changes. Conclusions: In this, in vivo non-tumor pig model CA effectively destroyed the renal parenchyma while the impacted renal urothelium remained intact and did not undergo fibrotic changes, nor was urinomas or fistulas observed.
AB - Objective: To investigate to what extent the urothelium of the renal collecting system is affected when performing deep endophytic cryoablation. Methods: The study was conducted as an in vivo animal model with a total of 15 female pigs. Each animal was subjected to bilateral endophytioc renal cryoablation and randomized to a postoperative follow-up period of either one, two or four weeks. At the end of follow-up all animals had a magnetic resonance imaging (MRI) examination and bilateral nephrectomy was performed. On MRI-imaging the extent of the cryolesions, as well as signs of urinomas or fistulas, were examined. Histopathologic examinations were performed to investigate the effect on the urothelium. Results: All animals tolerated the procedure well without any postoperative complications. MRI examinations found the renal collecting system to be involved in the cryolesions at all three stages of follow-up and revealed no signs of hematomas, urinomas or fistula formations. Epithelial edema was found at all three stages of follow-up while significant parenchymal fibrosis adjacent to the urothelium was most pronounced in the four weeks of follow-up group. The urothelium was significantly affected with luminal hemorrhage as well as hemorrhage in and underneath the urothelium and urothelial dissociation from the underlying renal parenchyma. Despite these impacts on the urothelium, this was found to be intact and vital at all three stages of follow-up, in sharp contrast to the renal parenchyma that underwent fibrotic changes. Conclusions: In this, in vivo non-tumor pig model CA effectively destroyed the renal parenchyma while the impacted renal urothelium remained intact and did not undergo fibrotic changes, nor was urinomas or fistulas observed.
KW - Renal cryoablation
KW - renal collecting system
KW - treatment of renal cancer
KW - RADIO-FREQUENCY ABLATION
KW - PARTIAL NEPHRECTOMY
KW - CLOSURE
UR - http://www.scopus.com/inward/record.url?scp=85082562111&partnerID=8YFLogxK
U2 - 10.1080/21681805.2019.1702094
DO - 10.1080/21681805.2019.1702094
M3 - Journal article
C2 - 31842655
SN - 0036-5599
VL - 54
SP - 33
EP - 39
JO - Scandinavian Journal of Urology
JF - Scandinavian Journal of Urology
IS - 1
ER -