title: Critical appraisal of consecutive 36 cases of post renal transplant lymphocele: a proposed algorithm.
abstract: BACKGROUND
  Lymphyocele by definition is the collection of lymph that is contained by a pseudomembrane. Management of lymphocele varies from simple aspiration or aspiration with sclerothreapy to more invasive technique, such as internal/external drainage. We present the results of 36 patients who developed pelvic lymphocele after renal transplant.
  
  
  METHODS
  A total of 1720 patients underwent living related donor renal allograft transplant at our centre. Of the total 1720 transplants 36 patients developed symptomatic lymphocele and underwent definitive management. Retrospectively analysis of the clinical data of these 36 patients was done.
  
  
  RESULTS
  Thrirt six patients (2.09%) had a clinically significant lymphocele, which needed definitive management. All these patients underwent ultrasound guided drain placement and sclerosant injection. Fifteen out of 36 patients (41.6%) had successful treament with percutaneous drain placement. Laparoscopic marsupialization of lymphocele was done in 21 patients who failed percutaneous drain insertion therapy after diagnostic aspiration. Laparoscopic Marsupilization was successful in 18 out of 21 patients (85.7%). The 3 patients with failed laparoscopic marsupialization were managed with open surgical marsupialization.
  
  
  CONCLUSIONS
  Significant number of lymphocele post renal transplant may be asymptomatic but still cause deterioration of renal function even without causing obstructive uropathy. Lymphoceles causing renal deterioration or symptoms should be managed in a step ladder fashion starting from percutaneous drainage to laparoscopic marsupilization to open surgical approach. Asymptomatic recurrences post marsupialization are common and should be only closely observed unless they become symptomatic or cause deterioration of renal function. A systematic protocol may help in treating these patients better.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India.
authors.forename: Abhishek G
authors.initials: AG
authors.lastname: Singh
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India.
authors.forename: Shrikant J
authors.initials: SJ
authors.lastname: Jai
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India. doctorarvind1@gmail.com.
authors.forename: Arvind P
authors.initials: AP
authors.lastname: Ganpule
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India.
authors.forename: Mohankumar
authors.initials: M
authors.lastname: VijayKumar
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India.
authors.forename: Ravindra B
authors.initials: RB
authors.lastname: Sabnis
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India.
authors.forename: Mahesh R
authors.initials: MR
authors.lastname: Desai
mesh_terms: D000465:Algorithms; D004322:Drainage / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008210:Lymphocele / Q000000981:diagnostic imaging / Q000628:therapy*; D010388:Pelvis; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D012597:Sclerosing Solutions
keywords: Laparoscopic marsupialization; Lymphocele; Percutaneous drainage; Post renal transplant