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Abstract
Chyluria is the passage of chyle in the urine. The cause seems to be the rupture of retroperitoneal lymphatics into the pyelocaliceal system, giving urine a milky appearance. This communication is caused by the obstruction of lymphatic drainage proximal to intestinal lacteals, resulting in dilatation of distal lymphatics and the eventual rupture of lymphatic vessels into the urinary collecting system.This condition, if left untreated, leads to significant morbidity because of hematochyluria, recurrent renal colic, nutritional problems due to protein losses and immunosuppression resulting from lymphocyturia.In this review, we summarize the state of the art of this condition and the newest treatments available.
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Tomisaki I, Hamasuna R, Fujimoto N. An Effective Case for Chyluria by Retroperitoneoscopic Lymphatic Disconnection. J Endourol Case Rep 2016; 2:78-80. [PMID: 27579424 PMCID: PMC4996603 DOI: 10.1089/cren.2016.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Chyluria is a rare disease in Japan. Lymphatic disconnection is the most effective treatment for patients with Chyluria, and laparoscopic approach is performed as a minimally invasive technique. Case Presentation: We present a case of a 40-year-old man who referred to our hospital because of recurrence of chyluria. Chyluria had continued for 20 years, and the patient had received retrograde instillations of silver nitrate three times. The patient underwent retroperitoneoscopic nephrolympholysis, and the chyluria disappeared immediately. One year after surgery, chyluria has not recurred. Conclusion: We treated a patient with chyluria by performing retroperitoneoscopic lymphatic disconnection and this procedure is less invasive and easy to perform.
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Affiliation(s)
- Ikko Tomisaki
- Department of Urology, University of Occupational and Environmental Health , Kitakyushu, Japan
| | - Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health , Kitakyushu, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health , Kitakyushu, Japan
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Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria in Presence of Complex Renal Vasculature. Urology 2012. [DOI: 10.1016/j.urology.2012.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zhang Y, Zeng J, Zhang K, Jin F, Ye J, Wu G, Wang G, Nie Z. Surgical management of intractable chyluria: a comparison of retroperitoneoscopy with open surgery. Urol Int 2012; 89:222-6. [PMID: 22868533 DOI: 10.1159/000341089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/25/2012] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Yao Zhang
- Department of Urology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
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Zhang Y, Ye J, Wu G, Yang H, Huo WQ, Lan WH, Zhang KQ, Jin FS. Transumbilical Laparoendoscopic Single-Site Renal Pedicle Lymphatic Disconnection for Refractory Chyluria. J Endourol 2011; 25:1337-41. [PMID: 21815794 DOI: 10.1089/end.2011.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yao Zhang
- Daping Hospital, Third Military Medical University, Chongqing, China
| | - Jin Ye
- Daping Hospital, Third Military Medical University, Chongqing, China
| | - Gang Wu
- Daping Hospital, Third Military Medical University, Chongqing, China
| | - Hua Yang
- Department of Urology, Qianjiang National Hospital, Chongqing, China
| | - Wen-qian Huo
- Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei-hua Lan
- Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ke-qin Zhang
- Daping Hospital, Third Military Medical University, Chongqing, China
| | - Feng-shuo Jin
- Daping Hospital, Third Military Medical University, Chongqing, China
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Zhang CJ, Chen RF, Sun XQ, Zhu HT, Wen RM, Wang JQ, Chen JC, Zheng JN. Comparison of Two Approaches to Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria. J Endourol 2011; 25:1161-5. [PMID: 21682592 DOI: 10.1089/end.2010.0520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cheng-Jing Zhang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Ren-Fu Chen
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Xiao-Qing Sun
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Hai-Tao Zhu
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Ru-Min Wen
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Jun-Qi Wang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Jia-Cun Chen
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Jun-Nian Zheng
- Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China
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Retroperitoneoscopic renal pedical lymphatic disconnection in the treatment of chyluria. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200808010-00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zhang X, Zhu QG, Ma X, Zheng T, Li HZ, Zhang J, Fu B, Lang B, Xu K, Pan TJ. RENAL PEDICLE LYMPHATIC DISCONNECTION FOR CHYLURIA VIA RETROPERITONEOSCOPY AND OPEN SURGERY: REPORT OF 53 CASES WITH FOLLOWUP. J Urol 2005; 174:1828-31. [PMID: 16217301 DOI: 10.1097/01.ju.0000176737.66172.15] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria has the advantages of minimal invasion and rapid recovery compared with open surgery.
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Affiliation(s)
- Xu Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Terashi H, Tahara S, Shibuya H, Sumino Y, Hirai K, Ohno H, Mimata H, Nomura Y. Treatment of filarial chyluria with lymphovenous shunt anastomosis: report of three cases in Japan. Plast Reconstr Surg 2003; 112:1049-53. [PMID: 12973222 DOI: 10.1097/01.prs.0000076188.94822.0b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hiroto Terashi
- Department of Plastic and Reconstructive Surgery, KobeUniversity, Japan.
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Zhang X, Ye ZQ, Chen Z, Chen ZQ, Zhu QG, Xin M, Li LC. Comparison of open surgery versus retroperitoneoscopic approach to chyluria. J Urol 2003; 169:991-3. [PMID: 12576828 DOI: 10.1097/01.ju.0000045090.45767.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We compared the clinical effectiveness of renal pedicle lymphatic disconnection for chyluria performed by retroperitoneoscopy and by open surgery. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS Retroperitoneoscopic renal pedicle lymphatic disconnection completely ligates the lymphatic vessels with minimal invasion, less blood loss, rapid recovery and a good short-term outcome.
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Affiliation(s)
- Xu Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Affiliation(s)
- A.K. HEMAL
- From the Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - N.P. GUPTA
- From the Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Hemal AK, Kumar M, Wadhwa SN. Retroperitoneoscopic nephrolympholysis and ureterolysis for management of intractable filarial chyluria. J Endourol 1999; 13:507-11. [PMID: 10569525 DOI: 10.1089/end.1999.13.507] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility of retroperitoneoscopic lymphatic disconnection in patients with intractable filarial chyluria with the aim of reducing the morbidity of the surgery. PATIENTS AND METHODS Two patients presented to us with intractable chyluria. They did not respond to conservative measures and endoscopic sclerotherapy. In view of the severe lipid and protein loss associated with recurrent bouts of chyluria, they merited surgical correction by lymphatic disconnection. Because this operation requires extensive mobilization within the retroperitoneum over a large area, it necessitates a large flank or midline incision. In order to reduce the incision-related morbidity, it was decided to undertake the procedure laparoscopically. The retroperitoneal route was chosen for its obvious advantages. RESULTS Surgery was carried out uneventfully in both patients, with a mean operating time of 2 hours. The patients stayed in the hospital for an average of 2.5 days. Chyluria resolved in the immediate postoperative period, and they have been asymptomatic over a follow-up of 30 and 18 months. One patient had drainage of lymph for 5 days, which resolved spontaneously. CONCLUSIONS The objectives of open surgery can be achieved by the minimally invasive approach of retroperitoneoscopy. The new approach significantly reduces the incision-related morbidity without compromising the principles of open surgery. We propose five important steps necessary to avoid recurrence and reduce postoperative morbidity.
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Affiliation(s)
- A K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi.
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Gomella LG, Shenot P, Abdel-Meguid TA. Extraperitoneal laparoscopic nephrolysis for the treatment of chyluria. BRITISH JOURNAL OF UROLOGY 1998; 81:320-1. [PMID: 9488081 DOI: 10.1046/j.1464-410x.1998.00325.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- L G Gomella
- Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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15th WORLD CONGRESS ON ENDOUROLOGY EDINBURGH, SCOTLAND, UK 31 August-3 September 1997 13th Basic Research Symposium. J Endourol 1997. [DOI: 10.1089/end.1997.11.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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