Masters M. Richards, MD, presents “Cryoablation of Small Renal Masses: Tips for the APP.”

How to cite: Richards, Masters M. “Cryoablation of Small Renal Masses: Tips for the APP.” Grand Rounds in Urology. Published September 24, 2025. Accessed Feb 2026. https://grandroundsinurology.com/video-summary-cryoablation-of-small-renal-masses-tips-for-the-app/

Cryoablation of Small Renal Masses: Tips for the APP – Summary

In this presentation, Hillary Durstein, MSN, APRN, NP-C, CUNP, FAUNA, interviews Masters M. Richards, MD, Vascular and Interventional Radiologist, Desert Radiology, Las Vegas, Nevada, focusing on cryoablation of small renal masses (SRMs).

Hillary Durstein and Dr. Richards begin by reviewing epidemiology: renal cell carcinoma accounts for roughly 90% of malignant renal tumors, with many stage T1a lesions (≤4 cm) detected incidentally, and about 17% present with metastases at diagnosis.

Ideal candidates for cryoablation include patients with small masses (<7 cm), significant comorbidities, or poor surgical candidacy. Guidelines (AUA/EUA) now support ablation as acceptable management for T1a lesions, alongside partial nephrectomy and active surveillance.

Dr. Richards explains the cryoablation procedural steps. Moderate sedation (fentanyl + Versed) is typically used. CT‑guided planning includes assessing tumor complexity using nephrometry scores. A biopsy is often performed; then cryoprobes are inserted and freeze-thaw cycles are executed to induce cell death via intracellular ice formation. The ablation tract is cauterized to minimize bleeding. Patients are monitored post-procedure and often discharged the same day with simple analgesia.

Complication rates are low: significant bleeding <5%, urine leak <1%, and neuropathy (like flank paresthesia) may occur up to ~10% and are usually transient. Non‑target injury or pneumothorax should be anticipated depending on anatomic proximity.

Case studies illustrate imaging before, during (ice-ball formation), and post-procedure—the latter showing a characteristic “divot” scar without enhancement, indicating successful ablation.

Surveillance typically includes contrast MRI at 3 months (to avoid confusion from inflammatory enhancement), then twice at 6‑month intervals, and annually thereafter, following NCCN guidelines.