Mathematical and Ex Vivo Thermal Modeling for Renal Tumor Radiofrequency Ablation with Pyeloperfusion

Background and Purpose: Radiofrequency ablation (RFA) is an effective technique for the treatment of patients with small renal tumors, although it is often limited to tumors at least 2 cm from the renal pelvis or ureter. Retrograde pyeloperfusion (PPF) of the pelvis with cold saline during RFA may protect the pelvis and ureter. We designed a mathematical and ex vivo model of RFA to investigate the effects of PPF. Methods: Our theoretical model uses heat transfer principles simplifying the RFA probe to a heat-emitting cylinder within a material. In the ex vivo model, an RFA probe was placed 18 mm from the pelvis in porcine kidneys and with temperature probes on either side of the RFA probe. Control trials with no PPF were compared with either cold saline (2°C), warm saline (38°C), or antifreeze (-20°C) pumped into the renal calix at a rate of 60 mL/min. Ablated volumes were measured and confirmed histologically. Results: The average steady state temperatures at each probe were highest with no PPF, followed by warm saline, cold saline, then antifreeze. Compared with no PPF, temperatures were significantly (P<0.05) colder with warm saline (-8.4°C), cold saline (-18°C), and significantly colder at the calix (warm -14°C, cold -27°C). While RFA output a constant voltage, significantly lower resistances in warm (171Ω) and cold (124Ω) PPF vs no PPF (363Ω) translated to significantly greater power outputs in warm (40 W) and cold (42 W) vs no PPF (14 W). The ablated volumes were significantly higher in warm saline (2.3 cm³) vs cold saline (0.84 cm³) and no PPF (1.1cm³). Mathematical modeling produced a predictive temperature curve with R2=0.44. Conclusion: PPF lowers temperatures throughout the entire kidney during RFA, most notably near the collecting system and is dependent on the temperature of the liquid used. In addition, PPF may cause less charring of the tissue around the probe resulting in lower resistance and higher power outputs.