Elsevier

Urology

Volume 74, Issue 6, December 2009, Pages 1246-1249
Urology

Laparoscopy and Robotics
Percutaneous Renal Cryoablation of Angiomyolipomas in Patients With Solitary Kidneys

https://doi.org/10.1016/j.urology.2008.09.005Get rights and content

Objectives

To determine the feasibility and safety of performing percutaneous cryoablation of angiomyolipomas (AMLs) in patients with solitary kidneys.

Methods

Three patients with AMLs involving a solitary kidney underwent computed tomography-guided percutaneous cryoablation. All lesions were located in the lateral/posterior part of the kidney, allowing for safe access from the skin for cryoprobe insertion. Intravenous sedation and local anesthesia were used for each patient. Follow-up computed tomography or magnetic resonance imaging and physical examination, urinalysis, and serum blood urea nitrogen/creatinine measurement were performed to evaluate for lesion recurrence and to evaluate the safety profile.

Results

Three tumors (1.2-2.5 cm) were treated. The patients experienced minimal to no pain during percutaneous cryoablation, and all were discharged the same day. No procedural or postoperative complications were noted. During the follow-up period (5-36 months), the first 2 patients had no radiographic evidence of recurrence. Initial follow-up imaging of the third patient displayed persistent AMLs.

Conclusions

A review of the published data suggested the necessity to prophylactically treat AMLs of solitary kidneys. In this series, percutaneous cryoablation proved a safe and effective method for treating these lesions. This ultimately provides a minimally invasive option for similar patients, potentially avoiding an open surgical procedure or the risk of hemorrhage.

Section snippets

Material and Methods

Three patients with AMLs involving a solitary kidney were identified at our institution. Two had undergone contralateral nephrectomy secondary to ruptured AMLs and the third because of urolithiasis. The lesions were 1.2-2.5 cm in diameter and located in a lateral/posterior position, allowing for safe access from the skin for cryoprobe insertion. Alternative available treatment options, including angioembolization, laparoscopic or open partial or total nephrectomy, and observation were

Case 1

A 49-year-old woman with a history of right nephrectomy secondary to a ruptured AML was noted to have a 1.6-cm contralateral AML on routine CT examination. Initially, the lesion was managed with observation until a subsequent scan demonstrated an increase in size to 1.9 cm. Percutaneous cryoablation was performed in June 2004. The preoperative BUN and creatinine value was 12 mg/dL and 1.3 mg/dL, respectively. The follow-up BUN and creatinine value at 1 year was 16 mg/dL and 1.4 mg/dL,

Comment

Renal AMLs are uncommon, occurring in approximately 0.1%-0.2% of the population, and generally considered to have a benign clinical course.1 Despite their nonmalignant nature, some lesions (generally those >4 cm) can enlarge and cause symptoms ranging from pain and hematuria to shock after rupture and hemorrhage.1, 2, 3 However, even with a nephron-sparing approach, surgical interventions of larger AML have a greater potential to negatively affect renal function, especially in patients with

Conclusions

The low prevalence of AML and limited prospective data, especially in clinical situations involving a solitary kidney or bilateral tumors, has made absolute treatment guidelines impossible. In the presence of a solitary kidney, lesions >4 cm should be treated, because numerous studies have established the risk of growth and hemorrhage with these lesions. The treatment of tumors <4 cm is controversial; however, variant growth patterns have been reported, and prophylactic treatment should be

References (19)

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