PMC7201462_01
(a) 18 mm medially located tumor of the right kidney. (b) Planning the optimal ablation needle insertion path. (c) Placing the needle electrode into the tumor under image guidance.
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A 70-year-old man underwent percutaneous RFA of an 18 mm renal tumor (Figure 1), after detailed explanation about risks, benefits, and the possibility of active surveillance, which he refused. AngioDynamics, Queensbury, NY, USA) with two overlapping ablation zones, each 4 cm in diameter, with an average ablation temperature of 105 C and an ablation duration of eight and ten minutes was performed (Figures 1(b) and 1(c)). A final CT scan, excluding postinterventional urinoma, perirenal bleeding, hydronephrosis, and pneumothorax, was performed, and the patient was discharged on the first postinterventional day.
(a) Ureteral stricture on retrograde pyelogram. (b) Insertion of a double-J stent in the upper part of the duplex kidney.
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A retrograde pyelography was performed, showing hydronephrosis of the upper part of the kidney and a jet phenomenon into the lower part, which was also dilated (Figure 2(a)). Semirigid ureteroscopy, using a 8/9.8-French ureteroscope (Wolf, Germany), failed due to a stenosis caused by scar tissue, but a guidewire could be placed in the upper part of the duplex kidney, and consecutively, a 7-French ureteral stent was placed via this guidewire (Figure 2(b)).
Antegrade nephrostogram with undisturbed contrast medium outflow through the lower kidney cavity system with the double-J stent still in situ.
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One week after the second procedure, an antegrade nephrostogram was performed, which showed an undisturbed contrast agent discharge into the urinary bladder (with the double-J stent still in place) (Figure 3).
PMC7201462_02
(a) 2 cm centrally located tumor of the left kidney before percutaneous RFA. (b) Planning the optimal ablation needle insertion path. (c) Needle with fully extended tine electrodes placed in the tumor.
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Four months after an uncomplicated percutaneous CT-guided RFA (at the request of the patient and performed in the same fashion as described in case 1) of a two-centimeter, biopsy-proven centrally located papillary RCC in the middle third of the left kidney (Figures 4(a)-4(c)), a 78-year-old female patient was sent to our hospital by her urologist because of a grade II hydronephrosis of the upper calyces of the left kidney.
(a) Filiform stenosis at the pyeloureteral junction on retrograde pyelogram. (b) Approach of the middle calyx with flexible ureterorenoscope. (c) Insertion of a double-J stent in the lower calyx.
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A filiform stenosis at the pyeloureteral junction was visible on retrograde pyelography (Figures 5(a) and 6(a)), which could be passed with a 0.035-inch guidewire. Thulium-YAG Laser (Boston Scientific, Massachusetts, USA), using a 230-micrometer laserfibre at 25 watts (Figure 6(b)). The lower and middle calyces could be accessed (Figures 5(b) and 6(c)), and an ureteral stent was placed in the lower calyx (Figure 5(c)). The postinterventional creatinine decreased to 1.7 mg/dl, and getting access to the upper calyces is planned in a subsequent procedure, utilizing the same approach and technique.
(a) Filiform stenosis at the pyeloureteral junction on flexible ureterorenoscopy. (b) Working up the stricture with a Vela XL Thulium-YAG Laser using a 230-micrometer laserfibre. (c) Access to the middle calyces with the flexible ureterorenoscope.
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Thulium-YAG Laser (Boston Scientific, Massachusetts, USA), using a 230-micrometer laserfibre at 25 watts (Figure 6(b)). The lower and middle calyces could be accessed (Figures 5(b) and 6(c)), and an ureteral stent was placed in the lower calyx (Figure 5(c)). The postinterventional creatinine decreased to 1.7 mg/dl, and getting access to the upper calyces is planned in a subsequent procedure, utilizing the same approach and technique.