title: Preoperative patient counseling for diagnostic renal biopsy and complications with renal radiofrequency ablation.
abstract: OBJECTIVE
  To identify preoperative factors associated with surgical complications and successful diagnostic renal biopsy in both laparoscopic and percutaneous radiofrequency ablation (RFA) of renal masses in order to help aid in preoperative patient counseling for renal RFA.
  
  
  METHODS
  We reviewed our Institutional Review Board approved database from November 2001 to January 2011, containing 335 tumors treated with either laparoscopic (LRFA) or percutaneous RFA (CTRFA). Preoperative patient demographics, tumor characteristics, and intraoperative surgical data were collected along with biopsy results and clinicopathologic outcomes.
  
  
  RESULTS
  RFA was performed on 335 renal tumors (124 LRFA, 211 CTRFA). Non-diagnostic biopsy occurred in 18 (5.5%) tumors. Of the 317 procedures performed, 121 complications occurred in 103 (30.7%) procedures. Multivariate analysis only showed CTRFA (vs LRFA) to increase the likelihood of non-diagnostic biopsy (OR 5.1, 95% CI 1.2-22, p = 0.032). Increased tumor size (p = 0.007) and synchronous ablations (p = 0.019) increased the risk for major complications, while decreased surgeon experience (p = 0.003) and tumors close to the collecting system (p = 0.005) increased the risk of any complication.
  
  
  CONCLUSIONS
  Preoperative recommendations can be made to patients in the future. We suggest counseling patients that when undergoing RFA, percutaneous approach increases the risk of non-diagnostic biopsy, increased tumor size increases the risk of major complications, having more than 1 tumor ablated increases the risk of a major complication, and tumors close to the collecting system may increase the risk of complications.
authors.affiliation: Division of Endourology, Department of Urology, Miller School of Medicine, University of Miami, 1400 NW 10th Ave, Ste 509, Miami, FL, 33136, USA, scott.castle.uro@gmail.com.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Castle
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.forename: Vladislav
authors.initials: V
authors.lastname: Gorbatiy
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Leveillee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D017115:Catheter Ablation; D003376:Counseling; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D007668:Kidney / Q000473:pathology* / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome