Current practice patterns in the use of ablation technology for the management of small renal masses at academic centers in the United States.

Objectives: To determine the current practice patterns in the use of ablation technology for the management of small renal masses at academic centers in the United States.

Methods: An email survey was sent to 112 academic urologists subspecializing in minimally invasive management of renal cancer. The survey consisted of 13 questions and 4 clinical scenarios pertaining to the use of ablation technology. The responses were then tabulated and analyzed to determine practice trends.

Results: The overall response rate was 62%. Ablation was offered by 93% of the academic urology centers and cryoablation was more frequently used (79%) than radiofrequency ablation (55%). Lack of sufficient efficacy data was the most prevalent reason (80%) for not offering ablation. The maximum size limit for offering ablation was 4 cm by 55% and 3 cm by 34% of the respondents. A collaborative approach using both radiologist and urologist was most commonly used (51%). Most urologists (68%) used both laparoscopic and percutaneous technique, depending on the tumor and adjacent organ location. Intraoperative ultrasound was universally used during the laparoscopic technique and was usually performed by the urologist (95%). Computed tomographic scan was the most frequently used imaging modality for percutaneous ablation (78%) and for surveillance of recurrent disease (81%). In a younger, healthy patient, most urologists recommend extirpative approach for the management of a small renal mass, whereas laparoscopic-assisted ablation was most commonly recommended for an elderly patient with comorbidities.

Conclusions: Our survey suggests that laparoscopic and percutaneous ablation is offered by the majority of academic centers for carefully selected patients.