Is Radiofrequency Ablation Safe for Solitary Kidneys?

Objectives: To determine the safety of radiofrequency ablation (RFA) in patients with a solitary kidney. Methods: We retrospectively reviewed the charts of all patients undergoing RFA at our institution for treatment of solid renal tumors and identified those with a solitary kidney. The clinical and radiographic characteristics were evaluated, including renal function, length of stay, use of blood products, and complications. The serum creatinine level and creatinine clearance rates were determined at baseline, within 1 week, and at the last follow-up visit. Results: Of the 100 patients who were treated with RFA for solid renal tumors from September 2001 to January 2006, 16 with a solitary kidney were identified. The mean patient age was 66.5 years, and the mean tumor size was 3.4 cm. The median preoperative creatinine level was 1.4 mg/dL. The median percentage of change in creatinine clearance within 1 week of ablation was 13.3% and at a mean follow-up duration of 15.3 months was 9.1%. All kidneys functioned postoperatively. All but 1 patient had maintained their renal function at the last follow-up visit. Major acute complications occurred in 4 patients and consisted of 3 cases of clot obstruction that were readily treated with ureteral stenting and 1 case of perinephric hemorrhage. Conclusions: RFA appears to maintain adequate renal function in select patients with a solitary kidney. When treating patients with central tumors in a solitary kidney, the urologist should be vigilant with regard to the need for ureteral stent placement with the onset of any hematuria.