Use of hydrodissection to prevent nerve and muscular damage during radiofrequency ablation of kidney tumors

Abstract

Muscular complications are uncommon but have been reported after radiofrequency (RF) ablation of renal tumors. Ablation of renal lesions near the psoas muscle may result in paresthesia in the distribution of the genitofemoral nerve. The present report describes a case of sensory and muscular dysfunction after RF ablation of a renal lesion lying on top of the psoas muscle that was treated without hydrodissection. To prevent this complication, hydrodissection was effectively used in two other patients during RF ablation of lesions abutting or in close proximity to the psoas muscle.

Figure 1

(a) CT scan before RF ablation shows left renal mass (arrow) abutting psoas muscle. (b) CT of left renal mass after RF ablation on the day of treatment without hydrodissection, resulting in muscular deficit and transient weakness with hip flexion.

Figure 2

Figures 2, 3. (2) CT after hydrodissection and before RF ablation shows left kidney displaced from psoas muscle with decubitus positioning and percutaneous instillation of 350 mL of 5% dextrose in water (arrow). (3) CT scan during RF ablation shows a left renal mass abutting the psoas muscle after instillation of 5% dextrose in water (white arrow) into the retroperitoneum, with the patient in a near-prone position. The ureter is seen medial to the kidney (black arrow) and is also protected by a fluid pocket.