Diagnosis and Treatment of Postoperative Lymphocele in Renal Transplantation

As a surgical complication of renal transplantation lymphocele account for as much as 6-18% complications reported by major referential series. The most common cause if lymphatic injury in the course of preparation of the iliac vessels of the recipients, i.e. unligated lymph vessels in the renal hilus of the donor. Other etiological factors, such as acute rejection, urinary obstructions or decapsulation of the graft my contribute to development of this serious complication. The treatment of large symptomatic lymphocele implies two basic methods: b) surgical approach with internal drainage and marsupialiyation, and b) percutaneous puncture and drainage. In our series (311 transplanted kidneys) the presence of lymphocele necessitating further therapy was recorded in 6.4% (18). Clinical picture was dominated by renal failure in 47%, stasis in the excretory system induced by external compression in 41%, and inguinal edema ion 53%, while scrotal edema, febrile infection, lymphorrhea and pain were less common (12-24%). Complete cure of the process with no interventional therapy ensued in 3 cases (17.6%). Puncture was applied in 29.4% (5 cases), while puncture with drainage and instillation of povidone iodide was applied in 12 patients (70.5%). Surgical therapy was applied in 2 patients (11.7%). The eventual response to the therapeutic procedures was satisfactory. The results obtained in our series suggest the need for prolonged drainage with instillation of povidone iodide as a satisfactory method in treatment of complicated lymphocele.