Chyle Leak following Open Donor Nephrectomy: A Rare Complication-A Case Report.

Introduction. Donor workup in renal transplantation is extensive. Despite this, chyle leakage following donor nephrectomy, a rare complication, has been reported in the literature. We encountered two cases of chyle leak in kidney donors in our series of open donor nephrectomies. Summary of Cases. After complete workup, standard open retroperitoneal donor nephrectomy with drain placement was performed in 684 living renal donors. We encountered chyle leak in two cases. The first case was a 33-year-old female who underwent an otherwise uneventful left donor nephrectomy but continued to have high drain output (upto 300-400 mL/24 hrs) in the postoperative period. The drain fluid was milky, raising the suspicion of chyle which was confirmed on biochemical analysis. The second case was a 42-year-old female with a similar case history. Both were managed conservatively with low-fat diet. The leak subsided spontaneously in three weeks and one week in the first and second patients, respectively. The drain was removed, and the patients remained symptom-free on followup. Conclusions. Both of our cases of chyle leak following open donor nephrectomy were managed successfully with conservative management. The management options and the experience of other centers are reviewed and discussed.

Rare etiology of obstructive uropathy: pelvic lipomatosis.

We present a case of a 32-year-old hypertensive and obese male who had bilateral obstructive uropathy, and who was diagnosed as having pelvic lipomatosis on the basis of clinicoradiological findings. Cystoscopy and biopsy revealed cystitis cystica. He was successfully managed with bilateral extravesical modified Lich-Gregoir ureteric reimplantation by intraperitoneal approach. At 5 months follow-up, the patient had normal serum creatinine and was clinically asymptomatic.

Clinically inapparent bilateral adrenal masses due to histoplasmosis.

Detection of bilateral adrenal masses in any patient often presents a management dilemma. Despite extensive imaging, positron emission tomography (PET) scanning, and fine needle aspiration biopsy (FNAB), a definite diagnosis may not be reached. We report an unusual case of bilateral adrenal mass diagnosed as histoplasmosis postoperatively and managed successfully by laparoscopy. Focus is placed on the role of laparoscopic adrenalectomy (LA) as a diagnostic and therapeutic tool in such patients.

Voided urinary cytology in bladder cancer: is it time to review the indications?

OBJECTIVES: The sensitivity of voided urinary cytology has been reported as very low. In this study, we investigated the sensitivity and clinical utility of voided urinary cytology in the detection of various grades and stages of transitional cell carcinoma (TCC) of the bladder compared with the urinary nuclear matrix protein-22 (NMP-22) qualitative assay. METHODS: From March 2004 to April 2006, all patients with TCC of the bladder receiving follow-up care and those presenting with gross hematuria were enrolled in this prospective study. These patients underwent urinary cytologic examination and NMP-22 qualitative assay. The diagnosis, determined from the cystoscopy findings and biopsy findings of the suspicious lesion, was accepted as the reference standard. RESULTS: A total of 196 patients were enrolled in this study, of whom 127 patients had previously been diagnosed with bladder TCC and 69 were presenting for investigation of gross hematuria. A total of 52 cases of bladder TCC were diagnosed. The overall sensitivity of voided urine cytology and NMP-22 assay was 21.1% and 67.3%, respectively (P <0.001). The sensitivity of urinary cytology and urinary NMP-22 for well-differentiated tumors was 9.5% and 52.4%, respectively, and was 18.1% and 77.3%, respectively (P <0.001), in moderately differentiated tumors. The overall specificity of urinary cytology for TCC of the bladder was 98.6% and was greater than the specificity of NMP-22 (80.5%). CONCLUSIONS: The results of our study suggest that urinary cytology has a very low sensitivity and can be omitted in favor of NMP-22 in the follow-up of low-grade superficial bladder TCC.

Ureteroscopy: savior to the gynecologist? Ureteroscopic management of post laparoscopic-assisted vaginal hysterectomy ureterovaginal fistulas.

Iatrogenic ureteral injuries are among the most serious complications in gynecologic surgery. With the increasing popularity of laparoscopic gynecologic surgery, the incidence of ureteral injuries is on the rise. We report 2 cases of post laparoscopic-assisted vaginal hysterectomy (post LAVH) ureterovaginal fistulas, which were managed successfully with retrograde stenting using ureteroscopy. Three middle-aged women who underwent LAVH for symptomatic myomas of the uterus presented with ureterovaginal fistulas in the late postoperative period. Excretory urography revealed ureterovaginal fistulas involving the distal ureter. Retrograde stenting was possible in 2 patients, using a 7.5F rigid ureteroscope. Both patients became continent 2 days after surgery. Urography at 6 weeks revealed normal renal function without obstruction or extravasation of urine, and the stents were removed. Stenting failed in the third patient; the patient underwent a ureteric reimplantation successfully. Post LAVH ureterovaginal fistulas are amenable to ureteroscopic retrograde double-J stenting, which enables spontaneous recovery of the injured ureter. An attempt of ureteroscopic stenting should be considered in all patients with post LAVH ureterovaginal fistulas before subjecting them to other modalities.