Rabley Andrew, Pavlinec Jonathan, Kwenda Elizabeth, Kuo Jennifer, Yeung Lawrence
Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA.
University of Florida College of Medicine, Gainesville, Florida, USA.
J Endourol Case Rep. 2020 Dec 29;6(4):409-412. doi: 10.1089/cren.2020.0160. eCollection 2020.
Chyluria is a rare diagnosis classically associated with milky-appearing urine. It involves the leakage of chyle into the urinary tract. Although the most common cause of chyluria worldwide is infectious in nature, other noninfectious etiologies have been described. Classically chyluria resolves spontaneously or with conservative management. Surgical treatments have been described but are not often required. We present a case of iatrogenic pyelolymphatic fistula after robot-assisted laparoscopic dismembered pyeloplasty that was treated with endoscopic electrocautery of the fistulous tract. A 50-year-old Caucasian man underwent a robot-assisted laparoscopic dismembered pyeloplasty with stent insertion for radiographically demonstrated left ureteropelvic junction obstruction. His postoperative course was uneventful until 4-week follow-up at which time he began to notice intermittent passage of milky-appearing urine. Urinalysis was notable for large protein and elevated urine triglycerides. He was initially managed conservatively dietary modifications without success. He then underwent endoscopic management with cystoscopy and ureteroscopy with fulguration of suspected pyelolymphatic fistula. He was maintained on a low-fat medium-chain triglyceride diet and octreotide injections while inpatient for 1 week postoperatively. His postoperative course was unremarkable and no return of chyluria was observed. His chyluria remained resolved at 9 months postoperatively. Pyelolymphatic fistula after robot-assisted laparoscopic pyeloplasty is a theoretical complication of perirenal dissection and has not been previously described in the literature. It should be considered as a rare iatrogenic cause of chyluria. Endoscopic management with fulguration is technically feasible and may obviate the need for more invasive surgical management.
乳糜尿是一种罕见的诊断，典型表现为尿液呈乳白色。它涉及乳糜漏入尿路。尽管在全球范围内，乳糜尿最常见的病因是感染性的，但也有其他非感染性病因的描述。传统上，乳糜尿可自发缓解或通过保守治疗治愈。虽然有手术治疗的报道，但通常并不需要。我们报告一例机器人辅助腹腔镜肾盂成形术后医源性肾盂淋巴管瘘的病例，该病例通过瘘管的内镜电灼术进行治疗。一名50岁的白种男性接受了机器人辅助腹腔镜肾盂成形术并置入支架，以治疗影像学显示的左肾盂输尿管连接处梗阻。他的术后过程顺利，直到术后4周随访时，他开始注意到间歇性出现乳白色尿液。尿液分析显示大量蛋白质和尿甘油三酯升高。他最初接受饮食调整的保守治疗，但未成功。随后他接受了内镜治疗，通过膀胱镜和输尿管镜对疑似肾盂淋巴管瘘进行电灼。术后住院期间，他维持低脂中链甘油三酯饮食并注射奥曲肽1周。他的术后过程无异常，未观察到乳糜尿复发。术后9个月时，他的乳糜尿仍未复发。机器人辅助腹腔镜肾盂成形术后的肾盂淋巴管瘘是肾周解剖的一种理论上的并发症，此前文献中尚未有描述。它应被视为乳糜尿罕见的医源性病因。内镜下电灼治疗在技术上是可行的，可能无需进行更具侵入性的手术治疗。
