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LAPAROSCOPIC LYMPHO-RENAL DISCONNECTION FOR IDIOPATHIC
UNILATERAL SPONTANEOUS CHYLURIA
Juan BORTAGARAY, Nathalie WEBB, Colin BROOK and Christopher KIMBER
MONASH CHILDREN'S, PAEDIATRIC UROLOGY, Clayton, AUSTRALIA
INTRODUCTION
Chyluria is the passage of milky urine, due urinary excretion of fat and triglycerides. It is most frequently seen in adults
due to abnormal chylo-urinary communications secondary to filarial infection, and is often bilateral. Unusual causes
include trauma, tuberculosis, tumours or congenital lymphatic malformations. The authors present a video of a
laparoscopic lympho-renal disconnection, for a case of unilateral idiopathic chyluria.
MATERIAL AND METHODS
A 15 year old male presented with 2 month history of acute-onset milky urine, most obvious in the morning. He also
had weight loss (10 kg), nephrotic range proteinuria (5 g/day) and triglyceriduria (25.3 mmol/L). Tests for Wucheria
bancrofti and tuberculosis were negative. There was no history of trauma. MR lymphangiography identified no obvious
anomaly.
Cystoscopy found efflux of milky urine from the right ureteric orifice. Retrograde pyelography demonstrated
urolymphatic fistulae from posterior upper and interpolar calyces.
Laparoscopically, complete lympho-renal disconnection was performed; ligating and dividing large lymphatics. After
complete lymphatic stripping, synthetic, biodegradable cyanoacrylate glue (Glubran®; GEM Italy) was atomised over
the renal surface and hilar vessels, to seal smaller vessels and achieve nephropexy.
RESULTS
Operative time was 150 minutes with minimal blood loss. Abdominal drain was left in situ for 24 hours. Urine clearance
was immediate. Patient was discharged on post-operative day 2.
At 6 week review, the patient had recovered lost weight, urine remained clear and urinary triglycerides were 0.1mmol/L.
CONCLUSIONS
The authors present a novel surgical technique for managing chylo-urinary fistulae, comprising complete laparoscopic
lympho-renal disconnection and cyanoacrylate glue sealing.