Surgical treatment for pelvic lipomatosis using a bladder-sparing technique

Abstract

The aim of this study was to report the experience and long-term efficacy of a novel surgical treatment for pelvic lipomatosis (PL) using a combination of pelvic fat mass extirpation and ureteral reimplantation. Data of 8 patients with PL who underwent pelvic fat mass extirpation and ureteral reimplantation at our hospital from September 2010 to March 2018 were retrospectively reviewed. Demographics, serum creatinine level, radiographic changes, perioperative complications, and patient-reported outcomes were evaluated. Surgeries were performed successfully without severe perioperative complications in all 8 patients. Median operating time was 150 minutes with a median estimated blood loss of 75 mL. Patients were discharged after a median of 8.5 postoperative days. Imaging studies at the first follow-up revealed varying extents of alleviation of hydronephrosis and 3 patients’ urinary symptoms were gradually relieved after surgery. During a median follow-up of 48.5 months (range, 10–100 months), all patients exhibited excellent surgical outcomes without evidence of disease progression, except 1 patient who underwent radical cystectomy with Bricker ileal conduit surgery due to hydronephrosis recurrence in the 49th postoperative month. Based on these cases, pelvic fat mass extirpation and ureteral reimplantation is a safe and effective surgical treatment for PL.

Surgical treatment of pelvic lipomatosis: a systematic review of 231 cases

“…However, PL patients still face the problem of recurrent ureteral stricture caused by continued growth of pelvic fat after ureteral reimplantation. 2,19,29 On the one TherapeuTic advances in urology hand, the growing pelvic fat may compress the replanted ureter again, resulting in recurrent ureteral stricture. On the other hand, the growing pelvic fat may further increase the pressure in the bladder after pressing the bladder, resulting in poor urine drainage.…”

Pelvic lipomatosis with cystitis glandularis managed with cyclooxygenase-2 inhibitor: A case report

“…PL is a rare disease of benign proliferation. Because of the subtle symptoms of early PL, some elderly male patients may be missed, and the incidence may be under-estimated[ 7 ]. Subsequently, patients with advanced disease are troubled with haematuria, unendurable LUTS, or gastrointestinal symptoms, such as constipation, nausea, lower abdominal pain, or progressively increasing back pain.…”

Robotic Management of Pelvic Lipomatosis—Experience with Difficulties Encountered and the Techniques to Successful Outcomes

“…First, such a procedure was reported by Halachmi et al [28] in 1996 using an ultrasonic-assisted lipectomy device. Ge et al [7] reported promising results in a series of eight patients who underwent laparoscopic bladder fat extirpation and B/L ureteric reimplantation with a median follow-up of 48.5 mo, and only one patient had recurrence at 49 mo. However, long-term efficacy is not available.…”

“…With the evolution of technology over the years, minimal-access bladder-sparing surgeries have been performed with a good success rate. Ge et al [7] published a series of eight cases (second largest series over a period of eight years) who underwent laparoscopic procedure with good outcomes. We present our experience of robotic-assisted bladder-sparing surgery with good short-term outcomes, and it is the first series from India.…”