Mediathek

Abstract

Management of urine leak after laparoscopic cyst decortication by robot assisted calcyeal closure

J.-U. Stolzenburg, V.K.A. Arthanareeswaran, H.M. Do, A. Dietel
Universitätsklinikum Leipzig, Leipzig, Deutschland

Introduction: Laparoscopic decortication (LD) is the treatment of choice for large simple renal cysts. We report the management of postoperative complications of a patient who underwent LD with persistent urine leakage from the cyst
cavity.
Materials and methods: A 67 year old patient presented with a large recurrent 15cm cyst of the right kidney. The patient had undergone ureterorenoscopic stone extraction of the right kidney preoperatively which did not reveal any
communication between the cyst and the pelvicalyceal system. The patient was posted for LD of the cyst. Urine leakage was detected intraoperatively following administration of Lasix and indigocarmine blue. The calyceal defect was closed using 3-0 vicryl. A drainage tube was placed during the surgery.
Results: Postoperative analysis of the drainage output revealed presence of urine. A retrograde ureteropyelographie was performed due to persistent urine leakage which revealed contrast extravasation and a DJ Stent was inserted. The patient continued to have urine leakage in the drain. An ureteroscopic coil embolization of the calyeal defect along with Histoacryl glue administration was attempted which was also unsuccessful. The patient was posted for robot assisted closure of the calyceal defect. A 1.5cm defect was identified and closed in layers using 4-o Monocryl suture. The defect was further sealed using fibrin glue intraoperatively. The urine leakage arrested postoperatively. The patient recovered well and was discharged subsequently following removal of drainage.
Conclusions: Management of simple renal cyst can be challenging. Preoperative exclusion of cyst communication with the pelvicalyceal system is necessary in all patients undergoing LD.