Renal Pedicle Lymphatic Disconnection Research Articles

Evaluation of the Effects of Silver Nitrate Renal Pelvic Instillation and Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria

Introduction: In this study, the efficacy, advantages, and disadvantages of transurethral cystoscopic silver nitrate renal pelvic instillation and retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria were compared to provide a clinical reference. Methods: Forty patients with chyluria who were admitted to our hospital between June 2007 and June 2017 were selected as the research subjects and divided into two groups. The patients in group A (n=25) were treated with transurethral cystoscopic silver nitrate renal pelvic instillation regimen, while those in group B (n=15) were treated by retroperitoneoscopic renal pedicle lymphatic disconnection. Operative time, intraoperative blood loss volume, length of postoperative hospital stay, cure rate, complication rate and recurrence rate were compared between the two groups. Results: All the 40 patients were successfully treated. Group B had a higher cure rate, lower complication rate and lower recurrence rate than in group A, the differences were statistically significant (P < 0.05). But group A had a shorter length of hospital stay and less surgical trauma, the differences were statistically significant (P < 0.05). Conclusion: Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria can be used as one of the first choices of treatment for chyluria. Although the recurrence rate with transurethral cystoscopic silver nitrate renal pelvic instillation is high, the treatment can be administered again when the disease recurs. At the same time, it is less invasive to the patients and they are more receptive.

Outcome of three kinds retroperitoneoscopic renal redicle lymphatic disconnection in a single center

Objective To present the experiences of three kinds retroperitoneoscopic renal pedicle lymphatic disconnection(RRPLD) and to evaluate the clinical outcomes in patients treated with three different approaches . Methods From January 2012 to December 2017, 141 patients with chyluria who underwent surgical treatments in our hospital were collected(58 males and 83 females). Thirty-four patients underwent traditional RRPLD, 64 patients underwent modified RRPLD and 43 patients underwent simplified RRPLD. The differences of operative time, intraoperative blood loss, postoperative bed time, anal exhaust time, postoperative hospital stay, follow-up recurrence rate and postoperative pain score(VAS) were compared. Results All surgeries were performed successfully. Simplified RRPLD was superior to modified and traditional RRPLD in terms of operative time, intraoperative blood loss, postoperative bed time, postoperative hospitalization time, postoperative VAS, the differences were statistical significance(P<0.05). There was no statistical difference in surgical complications and recurrence rate among the three groups. Conclusions Compared with traditional and modified RRPLD, simplified RRPLD has the similar results.Simplified RRPLD procedure is more simple and has the advantages of shorter operation time, less bleeding and quick recovery after operation, it is a feasible and effective surgical method in the treatment of chyluria. Key words: CHYLURIA; Lymphatic Vessels; Ligation; Laparoscopy

The role of lymphography in diagnosis and treatment of chyluria

Objective To evaluate the use of unilateral pedicle lymphography(PLG) in preoperative localization and treatment of chyluria. Methods From October 2010 to March 2017, 25 cases with severe chyluria and undergoing cystoscopy and unilateral PLG before renal pedicle lymphatic disconnection were reviewed. There were 11 males and 14 females, aged 44-71 years, with an average of 58.5 years. The course of the disease was 6 months to 30 years, with an average of 8.3 years.Of them, 18 cases had undergone unilateral PLG and spiral CT angiography preoperatively. Surgical treatment was performed according to PLG imaging. Results Unilateral ureteral chyluria was discovered in 16 out of the 19 cases through cystoscopy, with the sensitivity of 84.2%(16/19). In contrast, unilateral chyluria was only detected in 4 of the other 6 patients with bilateral chyluria. Albiduria were found in the remaining 5 cases in bladder, without ureteral excreted chyle. The sensitivity for chyluria positioning by cystoscopy was 64.5%(20/31). The location of lesion in 19 patients with unilateral chyuria and 6 patients with bilateral chyluria could be correctly displayed by PLG and the sensitivity was 100%(31/31). There was no significant difference in location between cystoscopy and PLG in 19 patients with unilateral chyluria (P=0.2482). But in total lesion location, the sensitivity of PLG was higher than cystoscopy(P=0.0026). Eighteen patients who had undergone PLG combined with spiral CT angiography, could not only locate the chylous fistula, but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels. Chyluria had disappeared immediately after unilateral renal pedicle lymphatic exfoliation in 23 patients. However, it still presented in the other 2 patients who were confirmed contralateral pyeloymphatic fistulas by PLG 3 months after surgery and cured by reoperation. Chyluria recurred in 6 cases during follow-up of 6 to 58 months, and 4 were confirmed bilateral pyelolymphatic fistulas by PLG. Two of these 4 cases were cured by laparoscopic surgery or open surgery, respectively. The other 2 patients were cured by conservative treatment. Moreover, 2 patients with unilateral chyluria recurred in situ after the first laparoscopic surgery, which was confirmed by PLG. Notably, all these patients were cured by ESWL finally. Conclusions This study suggested that PLG displays remarkable advantage in terms of localization sensitivity. PLG combined with spiral CT angiography preoperatively can not only locate the chylous fistula, but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels. Depending on PLG and spiral CT angiography, renal pedicle lymphatic disconnection can effectively protect renal vessel. In addition, it can avoid the omission of ligation for perivascular lymphatic vessels. Furthermore, PLG plays a key role in temporarily obstructing the leakage of pyelolymphatic fistulas to some extent. Key words: Chyluria; Pedicle lymphography; Cystoscope; CT angiography

V35 - Icg-guided Laparoscopic Renal Pedicle Lymphatic Disconnection: A Novel, Targeted Treatment for Chyluria

V35 - Icg-guided Laparoscopic Renal Pedicle Lymphatic Disconnection: A Novel, Targeted Treatment for Chyluria

It is unnecessary to completely mobilize the kidney in retroperitoneoscopic renal pedicle lymphatic disconnection for intractable chyluria.

To compare the efficacy and safety of two approaches in retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) for intractable chyluria: completely or partly mobilize the kidney. Retrospectively reviewed the clinical data of 77 patients, who underwent RRPLD because of intractable chyluria in our institution. We mobilized the whole affected kidney in 22 patients during the operation, but only dissected the lower part in other 55 patients. Operative time, blood loss, visual analog scale (VAS) score, postoperative bed rest, postoperative hospital stay, recurrence, intraoperative and postoperative complications were compared between the two groups. All operation was successful, and none convert to open. The chyluria was resolved immediately after surgery. Compared with completely mobilized RRPLD (CMR), partly mobilized RRPLD (PMR) was superior in terms of operative time (132.91±35.65 vs. 91.73±24.14min), blood loss (35.68±8.21 vs. 25.09±7.41ml), VAS score (4.63±0.44 vs. 2.34±0.80), postoperative bed rest (3.36±0.49 vs. 1.80±0.85 days) and hospital stay (6.77±1.57 vs. 4.98±1.89 days). Compilations occurred in three patients in CMR group and two in PMR. Recurrence was confirmed by cystoscopy in three patients during 3-103-month follow-up, CMR group with 1 and PMR with 2. In our study, we found PMR was equally effective and safe as CMR. Moreover, it is more minimally invasive, painless and economical. Therefore, we believe it is unnecessary to completely mobilize the kidney in RRPLD for intractable chyluria.

AB197. Modified retroperitoneoscopic renal pedicle lymphatic disconnection for intractable chyluria

ObjectiveTo describe a modified retroperitoneoscopic renal pedicle lymphatic disconnection (MRRPLD) and to compare the efficacy and safety of MRRPLD with traditional retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD).MethodsFrom September 2008 to July 2012, RRPLD and MRRPLD were performed respectively on 18 and 14 patients at our center. Comparison was conducted including operative time, intraoperative blood loss, postoperative time of bed rest, hospital stay, postoperative urine chyle test, and complications. All operations were completed without conversion to open surgery. The mean operative time, intraoperative blood loss, postoperative time of bed rest, and hospital stay from MRRPLD group were all decreased compared with data from RRPLD group.ResultsThere was significant difference in operative time, postoperative time of bed rest, and hospital stay (P<0.05). Complications occurred only in one patient receiving RRPLD. Chyluria disappeared in all patients after the operation. No recurrence was observed during the follow-up.ConclusionsMRRPLD has a good effect and safety for chyluria. It is a simpler, more minimally invasive, and more economic surgical therapy compared with traditional RRPLD.

V10-11 ROBOTIC URETEROLYSIS AND SKELETONIZATION OF THE RENAL HILUM FOR SEVERE CASE OF INTRACTABLE CHYLURIA

You have accessJournal of UrologyRobotics – Benign Disease1 Apr 2015V10-11 ROBOTIC URETEROLYSIS AND SKELETONIZATION OF THE RENAL HILUM FOR SEVERE CASE OF INTRACTABLE CHYLURIA Jay Sulek, Andrew Colhoun, Joseph Habibi, and Lance Hampton Jay SulekJay Sulek More articles by this author , Andrew ColhounAndrew Colhoun More articles by this author , Joseph HabibiJoseph Habibi More articles by this author , and Lance HamptonLance Hampton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2458AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chyluria is thought to be caused by the rupture of lymphatic channels into the urinary collecting system. Disturbances in lymphatic flow can result in increased pressure of retroperitoneal lymphatic drainage. This increased pressure can result in dilatation, proliferation, and valvular incompetence of lymphatic channels and can ultimately lead to fistulous communications with the urinary tract. Possible causes of chyluria, then, share in common the ability to cause lymphatic obstruction. These include filariasis, trauma, neoplasm, congenital lymphatic malformation, infection, and iatrogenic (usually after partial nephrectomy). Chyluria is a rare entity in the United States. However, in regions where Wuchereria bancrofti is endemic, as many as 10% of the population can be infected and 2-10% of these individuals on average experience chyluria. Presenting symptoms generally include intermittent or persistently milky white urine, flank pain, weight loss, anemia, and urinary hesitancy due to chyle clot formation. More severe symptoms can include nutritional deficiency, fatigue, and immunosuppression from protein wasting. Treatment options include dietary modifications, endoscopic fulgaration, open vs. laparoscopic lymphatic disconnection, autotransplantation, and nephrectomy. METHODS The Intuitive da Vinci Si System was used to perform a robotic-assisted laparoscopic right sided ureterolysis and skeletonization of the right renal vessels on a 54 year old woman with chyluria which did not respond to endoscopic attempts at fulgaration of lymphatic fistulae. RESULTS Total operative time was 83 minutes. Robotic console time was 68 minutes. Patient had complete resolution of chyluria immediately following surgery. Result was durable at three month follow up. CONCLUSIONS Prior research has shown a benefit of laparoscopic approach in achieving lymphatic disconnection for chyluria in terms of operative time, blood loss, duration of postoperative ileus, and hospital days as well as the suggestion of possible improved durability of response (Zhang et al, “Renal Pedicle Lymphatic Disconnection for Chyluria Via Retroperitoneoscopy and Open Surgery”). These authors have postulated that the higher long term recurrence rates after open compared to laparoscopic approach may be related to better visualization in laparoscopic approach. Robotic technology provides significant potential benefits in lymphatic disconnection in terms of magnification of small lymphatic connections which might otherwise be missed on open or pure laparoscopic approaches. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e848 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Sulek More articles by this author Andrew Colhoun More articles by this author Joseph Habibi More articles by this author Lance Hampton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AB124. Modified retroperitoneoscopic renal pedicle lymphatic disconnection for intractable chyluria

IntroductionTo describe a modified retroperitoneoscopic renal pedicle lymphatic disconnection (MRRPLD) and to compare the efficacy and safety of MRRPLD with traditional retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD).Technical considerationsFrom September 2008 to July 2012, RRPLD and MRRPLD were performed respectively on 18 and 14 patients at our center. Comparison was conducted including operative time, intraoperative blood loss, postoperative time of bed rest, hospital stay, postoperative urine chyle test, and complications. All operations were completed without conversion to open surgery. The mean operative time, intraoperative blood loss, postoperative time of bed rest, and hospital stay from MRRPLD group were all decreased compared with data from RRPLD group. There was significant difference in operative time, postoperative time of bed rest, and hospital stay (P<0.05). Complications occurred only in 1 patient receiving RRPLD. Chyluria disappeared in all patients after the operation. No recurrence was observed during the follow-up.ConclusionsMRRPLD has a good effect and safety for chyluria. It is a simpler, more minimally invasive, and more economic surgical therapy compared with traditional RRPLD.

A Case of Milky Urine Due to Chyluria

Chyluria is an uncommon condition characterized by lymphatic fluid excretion into the urinary tract. Most common cause of chyluria is the infection by parasites e.g. filariasis. Medical treatment is often insufficient to treat the cases of chronic chyluria for which the standard treatment is surgical renal pedicle lymphatic disconnection. However, sclerotherapy by instillation of a sclerosant agent into the renal pelvis may represent an alternative to surgery. This technique has the advantage of being less invasive. We are presenting two cases, presented to us with the complaint of milky urine for more than 3 years. All tests for infectious diseases remained negative. Chyluria was confirmed by urinary chyle test and urinary triglyceride. Cystoscopy showed a clear diagnosis of a milky urine jet from ureteric orifice. Retrograde pyelography revealed pyelolymphatic fistula in one case. Patients were treated successfully with renal pelvic instillation of diluted povidone iodine(0.2%). solution and non-ionic contrast(omnipac). We used sclerotherapy with povidone iodine solution as a safe, effective and minimally invasive treatment in our patient with chyluria. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18812 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 59-60

Modified Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Intractable Chyluria

To describe a modified retroperitoneoscopic renal pedicle lymphatic disconnection (MRRPLD) and to compare the efficacy and safety of MRRPLD with traditional retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD). From September 2008 to July 2012, RRPLD and MRRPLD were performed respectively on 18 and 14 patients at our center. Comparison was conducted including operative time, intraoperative blood loss, postoperative time of bed rest, hospital stay, postoperative urine chyle test, and complications. All operations were completed without conversion to open surgery. The mean operative time, intraoperative blood loss, postoperative time of bed rest, and hospital stay from MRRPLD group were all decreased compared with data from RRPLD group. There was significant difference in operative time, postoperative time of bed rest, and hospital stay (P <.05). Complications occurred only in 1 patient receiving RRPLD. Chyluria disappeared in all patients after the operation. No recurrence was observed during the follow-up. MRRPLD has a good effect and safety for chyluria. It is a simpler, more minimally invasive, and more economic surgical therapy compared with traditional RRPLD.

Modified retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of chyluria

Objective To investigate the efficacy of the modified retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of chyluria.Methods 58 cases treated in our hospital from January 2002 to June 2012 were analyzed retrospectively,including 34 male patients and 24 female patients with average age of 58 (23 to 78 years old).The clinical manifestation is milk-like chyluria.The course of history range from 1 year to 9 years.American Society of Anesthesiologists score are all class Ⅱ and the average Body Mass Index is 17.3 kg/m2.Thirty-six patients were undergone modified retroperitoneoscopic renal pedicle lymphatic disconnection,while another 22 cases were undergone traditional retroperitoneoscopic renal pedicle lymphatic disconnection.The peri-operative parameters and therapeutic results were recorded and analyzed,which includes mean operative time,postoperative bed stay,hospital stay,pain index and analgesics requirement.Results Modified retroperitoneoscopic and traditional retroperitoneoscopic surgery were performed successfully in 58 patients.Modified group showed statistically significant better results in term of operative time [range from 52 to 132 min,(86.8 ± 21.8) min on average],the postoperative bed-stay time [(1.7 ±0.5) days],pain index [(1.4 ±0.8) points],and the postoperative hospital stay [(6.8 ± 1.7)days].Comparatively,the results in traditional surgery group are inferior in term of operative time [range from 60 to 195 min,with (132.9 ±35.7) min on average],the postoperative bed-stay time [(3.4 ±0.5)days],the pain index [(3.7±0.8) points],and the postoperative hospital stay [(8.8 ±1.6) days].There were statistically significant difference between the two groups (P ＜ 0.05).All patients were followed up for 3 to 103 months.No recurrence,complications or nephroptosis were detected in both groups.Modified approach showed the same cure rate (100％) compared with traditional surgery.Conclusions Completely stripped of perirenal adipose capsule was avoided in modified surgery.It has the advantages of shorter operative time,shorter postoperative bed stay,shorter postoperative hospital stay and less pain. Key words: Chyluria; Modified; Retroperitoneoscopic; Operation

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria following abdominal surgery

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria following abdominal surgery

Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria in Presence of Complex Renal Vasculature

To evaluate retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) for chyluria in the setting of complex renal vasculature and compare those outcomes with the RRPLD outcomes of patients with normal renal vasculature. From December 2002 to December 2011, RRPLD was performed in 14 patients with complex renal vasculature and 64 patients with normal renal vasculature. Preoperative multislice spiral computed tomography angiography for renal vessels was done on 5 patients with complex vasculature. The demographic and perioperative data were collected to assess critical outcomes. The abnormal vasculature was identified using preoperative multislice spiral computed tomography angiography in 5 patients and surgical exploration in 9 patients. RRPLD was successfully completed in all patients without conversion to open surgery or vascular injury. The mean operative time was significantly longer in those with complex renal vasculature than those with normal renal vasculature (105.4 ± 18.7 vs 84.5 ± 15.6 minutes; P = .000). The outcomes were similar in the 2 groups in terms of intraoperative blood loss (P = .060), mean hospital stay (P = .478), and intraoperative complications (P = .660). The occurrence of postoperative gross hematuria was significantly greater in those with complex renal vasculature than in those with normal renal vasculature (4 of 14 vs 2 of 64; P = .008). The event was resolved uneventfully. Although it is technically challenging, RRPLD is feasible and safe for patients in the presence of complex renal vasculature. Preoperative evaluation of the renal vasculature with multislice spiral computed tomography angiography is beneficial for managing abnormal renal vessels.

Surgical Management of Intractable Chyluria: A Comparison of Retroperitoneoscopy with Open Surgery

Background: Retroperitoneoscopic renal pedicle lymphatic disconnection has been described in the management of intractable chyluria. Methods: We retrospectively reviewed the clinical outcomes of 76 patients with intractable chyluria undergoing renal pedicle lymphatic disconnection via a retroperitoneoscopic (n = 59) or conventional open approach (n = 17). Operative time, intraoperative blood loss, volume of postoperative drainage, postoperative draining time, postoperative intestinal recovery, intraoperative and postoperative complications, and postoperative hospital stay were evaluated. Results: Compared with open surgery, retroperitoneoscopy was superior in terms of operative time, intraoperative blood loss, postoperative drainage, postoperative draining time, postoperative intestinal recovery time, and postoperative hospital stay. Recurrence developed in 2 patients due to the contralateral chylous efflux confirmed by cystoscopy during the period of 9–85 months of follow-up. Conclusions: With minimal invasion, sparing operative time, less blood loss, and rapid recovery, retroperitoneoscopic renal pedicle lymphatic disconnection can achieve at least the same clinical efficacy as open surgery.

Transumbilical Laparoendoscopic Single-Site Renal Pedicle Lymphatic Disconnection for Refractory Chyluria

To report our preliminary techniques and experience with transumbilical laparoendoscopic single-site renal pedicle lymphatic disconnection (LESS-RPLD) in seven patients with refractory chyluria. Between June 2009 and September 2010, seven patients with refractory chyluria underwent LESS-RPLD. In the patients, a 2- to 3-cm single inverted U-shaped supraumbilical incision was made, and a homemade single multichannel port using a surgical glove and three conventional trocars was placed into the abdominal cavity. Flexible electric coagulation hook and pliers were used for renal pedicle dissection. A straight ultrasound knife was used for lymphatic disconnection. All the operations were successfully completed without conversion to open surgery, although an additional 3-mm trocar was used to push the liver in one patient. The mean operative time was 125 (96-165) minutes. The mean blood loss was estimated to be 112 (50-250) mL. Chyluria disappeared in all patients after surgery and did not recur during the follow-up period (3-15, mean 8.3 mos). LESS-RPLD is safe and feasible, with favorable short-term outcomes and aesthetic effect.

Comparison of Two Approaches to Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria

The retroperitoneoscopic renal pedicle lymphatic disconnection has been performed mainly via a renal adipose (RA) capsule approach. In this study, we reported a novel technique via extra-adipose (EA) capsule approach and compared the two approaches for intractable chyluria. From December 2002 to March 2008, retroperitoneoscopic renal pedicle lymphatic disconnection was performed on 41 patients with 23 EA and 18 RA. The stripping of hilar vessels and ureterolympholysis were performed in both approaches, while the mobilization of the kidney was only performed in RA. Comparisons of the two approaches were conducted, including mean operative time, intraoperative blood loss, postoperative bed rest, and hospital stay, as well as operative outcome. Patients were treated successfully without major complications. EA showed the same advantages as RA in terms of intraoperative blood loss (54.9±19.3 mL vs 59.3±26.5 mL, P>0.05), postoperative hospital stay (6.6±1.0 d vs 7.2±0.9 d, P>0.05). Chyluria disappeared in all patients immediately after the operations. EA was significantly superior to RA in operative time (78.9±18.3 min vs 101.8±20.6 min, P<0.05) and the postoperative bed rest time (20.7±1.7 h vs 72.0±0.0 h, P<0.05). No recurrence or nephroptosis was diagnosed in any patient within the follow-up of 21 to 84 months. Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is safe and efficacious. EA offers significantly shorter operative time and earlier return to postoperative ambulation.

Looking at appearance of urine before performing a renal biopsy in nephrotic syndrome

Chyluria results from an abnormal connection between lymphatic bed and urinary tract, causing lymph leakage into the urine. The clinical picture often begins with the appearance of cloudy, milky urines accompanied by monolateral flank pain, malnutrition, weight loss and weakness. We report a case of chyluria that occurred in a young woman who was referred to our unit for nephrotic-range proteinuria. Before performing a renal biopsy, we found that urine analysis demonstrated a massive lipiduria. Therefore, we collected urine samples from each kidney with a selective ureteral catheterization, demonstrating a monolateral source of lipids and proteins. We suspended the renal biopsy and performed a lymphography that showed an inherited lymphangioma on the left lumbar lymphatic bed. Sclerosing solution instillation, renal pedicle lymphatic disconnection or laser therapy are invasive therapeutical options that may cause severe adverse effects. Instead of these procedures, a conservative therapy based on a low-fat diet supplemented with medium-chain triglycerides was chosen. This dietetic schedule was followed by complete resolution of proteinuria and lipiduria. The patient progressively gained body weight and improved quality of life. No relapses were observed after 3 years of follow-up. This case emphasizes the possible role of a noninvasive therapeutical option for patients with chyluria.

A comparison of retroperitoneoscopic and open surgical renal pedicle lymphatic disconnection for the treatment of serious filarial chyluria

A comparison of retroperitoneoscopic and open surgical renal pedicle lymphatic disconnection for the treatment of serious filarial chyluria

RENAL PEDICLE LYMPHATIC DISCONNECTION FOR CHYLURIA VIA RETROPERITONEOSCOPY AND OPEN SURGERY: REPORT OF 53 CASES WITH FOLLOWUP

We present our experience with retroperitoneoscopic renal pedicle lymphatic disconnection. We compared the clinical efficacy of this treatment for chyluria with that of open surgery. From January 1998 to June 2004, 53 patients (55 renal units) with chyluria underwent renal pedicle lymphatic disconnection via the retroperitoneoscopic and conventional open approaches. The diagnosis of chyluria was confirmed by the ether test and the side of chylous reflux was determined by cystoscopy. Operative time, intraoperative blood loss, postoperative intestinal recovery and hospital stay were evaluated. Increases in hemoglobin and serum albumin were compared before and after surgery during followup. Retroperitoneoscopic renal pedicle lymphatic disconnection or open surgery was performed successfully in all patients. In terms of operative time, intraoperative blood loss, postoperative intestinal recovery and hospital stay retroperitoneoscopy was superior to conventional open surgery. During retroperitoneoscopy the inferior vena cava was injured in 1 case but repaired successfully by laparoscopy without conversion to open surgery. Postoperative gross hematuria in 1 case disappeared 4 days later. In the open surgery group the renal segmental artery was inadvertently injured in 1 case and anastomosis was performed successfully. Wound healing was delayed in 1 case due to hypoalbuminemia. Recurrence developed in 2 patients during the 6 to 84-month followup. Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria has the advantages of minimal invasion and rapid recovery compared with open surgery.

Comparison of Open Surgery Versus Retroperitoneoscopic Approach To Chyluria

We compared the clinical effectiveness of renal pedicle lymphatic disconnection for chyluria performed by retroperitoneoscopy and by open surgery. Three male and 4 female patients 33 to 68 years old (mean age 49) with chyluria underwent retroperitoneoscopic renal pedicle lymphatic disconnection. Chyluria was on the left side in 5 cases and on the right side in 2. Open renal pedicle lymphatic disconnection was performed in 4 men and 2 women 33 to 61 years old (mean age 45.8). Chyluria was on the left and right sides in 3 cases each. Mean operative time, intraoperative blood loss, postoperative intestinal function recovery time, intraoperative and postoperative complications, postoperative hospital delay and operative outcome were compared in these 2 groups. Compared with the open surgery group results in the retroperitoneoscopic group were superior in terms of operative time (42 to 90 minutes, mean +/- SD 65.0 +/- 18.8 versus 120 to 220, mean 156.7 +/- 38.8), intraoperative blood loss (20 to 50 ml., mean 29.3 +/- 10.2 versus 60 to 250, mean 171.7 +/- 76.5), postoperative intestinal function recovery time (24 to 48 hours, mean 36.0 +/- 6.9 versus 24 to 72, mean 54.0 +/- 21.1), intraoperative and postoperative complications, and postoperative hospital stay (3 to 6 days, mean 4.7 +/- 0.7 versus 7 to 9 days, mean 7.8 +/- 1.0). In the open surgery group primary anastomosis was performed in 1 case due to injury to a renal artery branch during the operation. Chyluria resolved the day after surgery in the 2 groups. No obvious complications developed postoperatively. The followup of 2 to 12 months (mean 6.7 +/- 4.0) showed no recurrence of chyluria. Retroperitoneoscopic renal pedicle lymphatic disconnection completely ligates the lymphatic vessels with minimal invasion, less blood loss, rapid recovery and a good short-term outcome.