PMC9649948_01
CT scan showing (A): bilateral small renal masses in axial section s (red arrows), (B) left renal mass in lower pole with proximity to left upper ureter (blue arrow).
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Patient was found to have a bilateral renal mass on computed topography scan (CT) done for abdominal pain (Fig. 1).
Retrograde pyelogram showing left upper ureteric stricture and passed by guidewire and double J inserted.
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CT abdomen showed left hydronephrosis, retrograde pyelogram showed iatrogenic upper ureteric stricture (Fig. 2), primarily due to proximity of the ablated tumor to the upper ureter, for which double J stent (DJ) inserted retrogradely.
Nephrostogram showing obliteration of left upper ureter and antegrade DJ stent insertion.
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Follow-up ultrasound (US) showed the DJ in the upper ureter, so a left nephrostomy tube was inserted, nephrostogram showed no passage of contrast from the renal pelvis to the upper ureter, confirming the diagnosis of upper ureteric stricture and a DJ stent was inserted antegradely with subsequent resolution of pain and improvement in renal function Fig. 3.
Ultrasound of left kidney, (A) hydronephrosis, (B) after Memokath insertion resolution of hydronephrosis.
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Upon follow-up, 6 month after Memokath insertion, the patient was asymptomatic, hydronephrosis resolved (Fig. 4) and renal function improved (Fig. 5).
Triphasic CT scan during cryoablation procedure (A) showing the tumor in anterior lower calyx of left kidney in arterial phase (red arrow), (B) delayed excretory phase showing the close proximity of the tumor (yellow arrow) to the ureter (blue arrow), (C) the intraprocedural CT scan showing cryoablation of the tumor with possible involvement of the upper ureter (orange arrow).
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Cryoablation using Argon Gas was started for 10 minutes followed by passive thawing until temperature reached 0 which took almost 6 minutes followed by a 2nd cycle of Cryoablation for 10 minutes followed by active thawing using Helium Gas until temperature reached 30 Celsius and then the needles were removed (Fig. 6).
Intraoperative X-rays showing: Nephrostogram with upper ureteric blockage (A) bypass of the left upper ureteric stricture with guidewire and balloon dilatation (B-D). Memokath insertion in left upper ureter (E,F).
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We used second sensor guide wire to bypass the upper ureteric stricture, followed by Balloon dilatation and fixation of Memokath (Fig. 7A-F).