Chyluria after partial nephrectomy: A rare but considerable complication

Abstract

An 82-year-old male patient underwent open left lower-pole partial nephrectomy with a microwave tissue coagulator (Microtaze). Pathological findings showed clear cell renal cell carcinoma, pT1a, Fuhrman grade 2 with negative margins. Then 2 years later, he presented with urinary retention. His urine appeared cloudy and milky only after meals, but appeared normal at other times. He was diagnosed with chyluria after partial nephrectomy. Endoscopic sclerotherapy with silver nitrate was carried out, because his serum albumin decreased to 3.4 g/dL within 3 months. He had an uneventful postoperative course. His chyluria completely disappeared and has not recurred for 11 months. Although chyluria after nephrectomy is very rare, there is a possibility that the frequency of chyluria after partial nephrectomy might increase, because the number of partial nephrectomies continues to increase worldwide. We herein summarize this rare surgical complication and discuss the effectiveness of endoscopic sclerotherapy as a therapeutic tool.

Chyluria: what does the clinician need to know?

“…Combination drug treatments have also been applied and success is reported. 5 In endemic areas treatment can be given without demonstrating filarial antigen if it is suspected. Bed rest and abdominal binders are also recommended.…”

“… 3 , 4 Aetiological factors include blunt or penetrating trauma, a complication of surgery such as partial nephrectomy or aorto-iliac bypass, infection, malignancy, lymphatic malformation, radiation, abscess, congenital abnormalities, pregnancy and stenosis of the thoracic duct. 5 – 9 Acute myeloid leukaemia and testicular cancer are the most commonly described malignancies, which are associated with chyluria 10 ( Table 1 ).…”

Trans-urethral resection of bladder tumor (TURBT) and radiofrequency ablation of renal tumor: Rare etiologies of chyluria

“…Panchal and colleagues [2] reported 4 cases of chyluria, 3 post partial nephrectomy and 1 post radical nephrectomy. Also, Komeya and colleagues [19] reported a chyluria case after partial nephrectomy for renal cell carcinoma. Kazaoaka and colleagues [3] retrospectively reviewed postoperative CT images from 123 patients who underwent surgery for renal tumors (92 patients after partial nephrectomy and 31 after total nephrectomy).…”

Chyluria: The State of the Art

“…Only two of these four patients noted occasional cloudy urine and none had intervention due to their asymptomatic nature. Komeya et al described, as well, a case of chyluria after partial nephrectomy, treated with endoscopic injection of silver nitrate solution (17). Thrasher and Snyder reported chyluria after percutaneous nephrolithotomy, which resolved with total parenteral nutrition and no other surgical intervention (18).…”