The Advantages of Unilateral Pedal Lymphography in the Diagnosis of Chyluria

Abstract

Objectives: To evaluate the efficacy and safety of pedal lymphography (PLG) in the localization diagnosis of chyluria. Methods: Cystoscopy was performed in 153 patients and PLG in 121 cases. Unilateral or staged bilateral ligation and stripping of renal lymphatic vessel were performed according to the results of cystoscopy and/or PLG. Results: Unilateral and bilateral urinary excretion of chyle was detected in 123 and 1 case by cystoscopy, respectively. In 121 cases receiving PLG, 100 cases of unilateral fistulous connection between the renal pelvis and the lymphatic system, 18 cases of bilateral fistulas and 1 case of lymphatic bladder fistula were demonstrated. PLG has a higher diagnostic rate for the detection of bilateral lymphatic renal pelvis fistulas than cystoscopy (p < 0.05). 28 cases received renal pedicle lymphatic disconnection only according to the results of cystoscopy, and 3 of them failed (10.1%). While 121 cases had the same operation according to the results of PLG, only 1 case failed the operation (0.8%). Conclusions: PLG was efficient and safe for the localization diagnosis of chyluria, with a higher detection rate of bilateral fistulas than cystoscopy. PLG might benefit the selection of appropriate therapy and improve the surgical effect.

Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography

“…Imaging studies in patients with severe chyluria generally include cystoscopy and LPG. LPG is more successful than cystoscopy in detecting bilateral lymphatic renal pelvis fistulas than cystoscopy [ 2 ]. The appearance of LPG images in these chyluria patients was wire-like, with semicircular or coralline-shaped shadows that were primarily distributed in the renal pelvis and parenchyma (Fig.…”

“…The etiologies include thoracic duct stenosis, tuberculosis, cancer, trauma, pregnancy, filariasis, or the cause may not be clear. The result is dilatation of distal lymphatics and the eventual rupture of lymphatic vessels into the urinary collecting system [ 1 , 2 ]. Although rare, severe fluid and protein loss may cause hypovolemia and hypoproteinemia in some patients.…”

“…Although rare, severe fluid and protein loss may cause hypovolemia and hypoproteinemia in some patients. Cystoscopy, lymphangiography (LPG), computed tomography (CT), magnetic resonance imaging (MRI) and lymphoscintigraphy are used to diagnose and locate the origin of chyluria [ 2 – 4 ]. Combining LPG with post-LPG CT imaging may increase the ability to locate chyle leaks [ 2 , 5 , 6 ]., MRI is contraindicated in patients with implanted metal devices.…”

“…Cystoscopy, lymphangiography (LPG), computed tomography (CT), magnetic resonance imaging (MRI) and lymphoscintigraphy are used to diagnose and locate the origin of chyluria [ 2 – 4 ]. Combining LPG with post-LPG CT imaging may increase the ability to locate chyle leaks [ 2 , 5 , 6 ]., MRI is contraindicated in patients with implanted metal devices. Some patients fail conservative management because their chyle leaks are not visualized by routine contrast CT, and require additional evaluation of the lymphatic system before treatment can be started.…”

Right-Crossed, Fused Renal Ectopia L-Shaped Kidney Type with Urinary Chyluria

“…After 2 min of gentle massage, the blue-dyed lymphangion could be seen when the skin incision had been made. CT and KUB were performed 30 min after the injection of contrast agent (Lipiodol Ultra-Fluide 10 ml with a 0.1-0.2 ml/min injection speed) [1] . Wire-like, half-round shadow could be seen at the kidney area with some contrast agent flowing into the bladder.…”