Surgical stripping of perihilar renal lymphatics for chyluria

ABSTRACT

To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria. Twenty patients [12 men and 8 women, age 32-65 years] with severe chyluria of variable duration [5 months to 4 years], underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules. All patients were either failed minimally invasive treatment with intrarenal pelvic instillation of sclerosing material [8 patients], or presented with severe chyluria [12 patients]. Cystoscopy was performed in all patients before treatment. Chyluria was seen to spurt from the ureteral orifice unilaterally in 16 patients and bilaterally in 4 patients. The areolar tissue containing dilated lymphatics traveling to the kidney in the perirenal and hilar regions was dissected and divided between ligatures, thus stripping these structures completely. Only one side was operated at a time. All patients were available for a minimum follow-up of 1 year, with the longest follow-up 3 years. With unilateral surgery, clearance was achieved in 15 patients [93.7%] immediately, with final success in 14 [87.5%] patients. Of the four patients who underwent bilateral surgery a clearance rate of 75% was achieved. In three cases of failure, instillation of sclerotherapy was successful in two patients but failed in one patients who cured by repeated surgery. Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Salvage sclerotherapy is usually effective for the minority of patients who fail surgical stripping