Research and reports in urology · 2025
Evaluation of Cervical Thoracic Duct Exploration in Idiopathic Chyluria: A Retrospective Comparative Study.
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Xin Jianfeng, Dong Chao, Xia Song, Sun Yuguang, Dong Jian, Chang Kun, Su Wanchun, Hao Kun, Qian Youlei, Shen Wenbin
Аннотация
PURPOSE: The purpose of this study is to evaluate a novel surgical method for idiopathic chyluria.
METHODS: Data from 63 patients with idiopathic chyluria who underwent direct lymphangiography (DLG) were retrospectively analyzed. Of these, 50 patients received cervical thoracic duct exploration (CTDE) as a treatment, while 13 were managed with a low-fat diet. The treatment efficacy of the two groups was compared, and a univariate analysis of the CTDE treatment effect was performed.
RESULTS: DLG revealed that the contrast agent passed upwards and outwards through paravertebral lymphatics into the region of the renal hilum and pelvis (left: 38.10%; right: 33.33%; bilateral: 28.57%). Dilatation of retroperitoneal lymphatics was found in 90.47% of cases. Additionally, 47.6% of patients demonstrated contrast agent reflux into lymphatic trunks in the neck (the percentage of contrast agent reflux to the jugular trunk, subclavian trunk, and broncho-mediastinal trunk being 28.57%, 38.09%, and 6.34%, respectively). The effective rate in the CTDE group was higher than in the low-fat diet group (χ² = 5.893, p=0.015). Univariate analysis of the patients who underwent CTDE demonstrated that younger age (p=0.036) and Grade III chyluria were risk factors for ineffective treatment, while patients with Grade I had better treatment outcomes (p=0.029).
CONCLUSION: Obstruction of the cervical thoracic duct may be a significant cause of idiopathic chyluria. Alleviating this obstruction may be an effective treatment strategy for idiopathic chyluria.
METHODS: Data from 63 patients with idiopathic chyluria who underwent direct lymphangiography (DLG) were retrospectively analyzed. Of these, 50 patients received cervical thoracic duct exploration (CTDE) as a treatment, while 13 were managed with a low-fat diet. The treatment efficacy of the two groups was compared, and a univariate analysis of the CTDE treatment effect was performed.
RESULTS: DLG revealed that the contrast agent passed upwards and outwards through paravertebral lymphatics into the region of the renal hilum and pelvis (left: 38.10%; right: 33.33%; bilateral: 28.57%). Dilatation of retroperitoneal lymphatics was found in 90.47% of cases. Additionally, 47.6% of patients demonstrated contrast agent reflux into lymphatic trunks in the neck (the percentage of contrast agent reflux to the jugular trunk, subclavian trunk, and broncho-mediastinal trunk being 28.57%, 38.09%, and 6.34%, respectively). The effective rate in the CTDE group was higher than in the low-fat diet group (χ² = 5.893, p=0.015). Univariate analysis of the patients who underwent CTDE demonstrated that younger age (p=0.036) and Grade III chyluria were risk factors for ineffective treatment, while patients with Grade I had better treatment outcomes (p=0.029).
CONCLUSION: Obstruction of the cervical thoracic duct may be a significant cause of idiopathic chyluria. Alleviating this obstruction may be an effective treatment strategy for idiopathic chyluria.