Elsevier

Urology

Volume 83, Issue 5, May 2014, Pages 1195-1198
Urology

Surgical Techniques in Urology
Modified Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Intractable Chyluria

https://doi.org/10.1016/j.urology.2013.12.030Get rights and content

Introduction

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).

Technical Considerations

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.

Conclusion

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.

Section snippets

Materials and Methods

Approval for the study was granted by the ethics committee of Nanjing Medical University (China), and informed written consent was received from patients.

Results

Demographic and preoperative clinical characteristics of 32 patients are presented in Table 1. Preoperative retrograde pyelography showed that the dilated fistulous connections between renal collecting system and retroperitoneal lymphatic vessels were all at renal pedicle and proximal ureter (Fig. 2). All operations were completed without conversion to open surgery. Each group had a case with bilateral chyluria. They underwent the same operation for persisting symptoms 3 months later.

The Foley

Comment

Chyluria can lead to physical discomforts, emotional disorders, hypoimmunity, and serious malnutrition. Timely diagnosis and treatments are important and essential. Typical symptoms, urine chyle test, and cystoscopy can easily make a definite diagnosis. Renal pedicle lymphatic disconnection can obstruct the leakage of chyle into renal calyces and pelvis through removing the abnormal communication between perirenal lymphatic vessels and urinary tract. With the development of minimally invasive

Conclusion

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.

References (14)

There are more references available in the full text version of this article.

Bianjiang Liu and Jiexiu Zhang contributed equally.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: This work was supported by grants from the National Natural Science Foundation of China (81270685) and by the Priority Academic Program Development of Jiangsu Higher Education Institutions (JX10231801).

View full text
Copyright © 2014 Elsevier Inc. All rights reserved.