UroToday- Caveat emptor! In the first article reviewed 16 patients with a solitary kidney were treated with radiofrequency ablation (RFA) via a 200 watt radiofrequency probe. Tumors ranged in size from 1.5 cm to 6. 5 cm with a mean of 3.4 cm. Multiple activations in an overlapping manner were used. The authors noted no retreatments or failures at a mean follow-up of 15 months among 14 patients. Of note, half of the patients at presentation had metastatic disease and were being treated for local control or palliation. Unfortunately, the fate of these two groups is not reported separately in this manuscript. What is disconcerting, as John Libertino points out in his editorial comment, is the short and long term major complication rate of 37%. Acutely, 3 patients developed anuria postoperatively from clot and required stent placement and one patient developed perirenal hemorrhage requiring transfusion. Chronically, one patient required late stent placement while a second patient went on to nephrectomy due to renal failure (n.b.: the cause of the renal failure was not provided). The authors' experience is not unique and indeed in this same issue of Urology there is yet another report of a nephrectomy following RFA. As Dr. Libertino sagely advises, with regard to RFA the "safety, oncologic efficacy, and its utility in solitary kidneys are major questions that need to be answered in the future." It is reports such as these that caused our group at the University of California - Irvine to cancel a planned prospective randomized study of RFA vs. cryoablation for small renal lesions. In over a decade of experience with cryoablation we have yet to experience a ureteral complication or need for subsequent nephrectomy. Presently, RFA is less expensive, easier, and quicker to use while cryoablation provides a superior ability to visualize the treatment area and less risk of damage to the collecting system. Longer term careful follow-up data are needed to determine the proper place of these modalities in the treatment regimen for renal cancer. In this regard, the importance of dogged follow-up of all patients undergoing percutaneous/laparoscopic ablation can not be overemphasized. Indeed, a national registry to track these cases is sorely needed.

(Disclosure: Dr. Clayman currently serves on a cryoablation advisory board for Endocare Inc, Irvine, California)

Jacobsohn KM, Ahrar K, Wood CG, Matin SF

Urology. 69(5):819-823, May 2007
doi:10.1016/j.urology.2006.11.027

Reported by UroToday Medical Editor Ralph V. Clayman, MD

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