Adult Urology Treatment of Recurrent Symptomatic Lymphocele After Kidney Transplantation with Intraperitoneal Tenckhoff Catheter Gian Luigi Adani, Umberto Baccarani, Andrea Risaliti, Daniele Gasparini, Massimo Sponza, Domenico Montanaro, Patrizia Tulissi, Dino De Anna, and Vittorio Bresadola OBJECTIVES The incidence of lymphocele after kidney transplantation ranges from 0.6% to 16%. The management of lymphocele is still controversial. Percutaneous needle aspiration and external drainage, with or without the injection of sclerosing solutions, are associated with high recur- rence and complication rates. Open or laparoscopic intraperitoneal marsupialization requires hospital admission, general anesthesia, and, sometimes, extensive surgical dissection. METHODS We report our experience treating recurrent symptomatic lymphocele with intraperitoneal drainage using a Tenckhoff catheter on an outpatient basis in 7 consecutive patients. In all cases, the lymphocele was diagnosed by abdominal ultrasonography 26 to 90 days after kidney transplantation. The mean diameter of the lymphocele was 14  6 cm. Percutaneous drainage was the initial approach, which was also used to differentiate between urinoma and lymphocele and to rule out infection. The lymphocele recurred within 1 month in all cases. The recurrent lymphoceles were treated on an outpatient basis using intraperitoneal drainage with a Tenckhoff catheter inserted into the lymphocele under ultrasound guidance. After administration of local anesthesia, two 1-cm vertical incisions were performed: one to access the lymphocele and the other to access the peritoneal cavity. A Tenckhoff catheter was inserted in the lymphocele and tunneled into the peritoneal cavity. RESULTS All procedures were completed on an outpatient basis without any complications. The catheter was removed 6 months later with no evidence of recurrent lymphocele at ultrasound follow-up in all cases. CONCLUSIONS This outpatient surgical approach using ultrasound-guided intraperitoneal drainage with a Tenckhoff catheter appears to be a simple, effective, and safe method for treating unilobular recurrent symptomatic lymphocele after renal transplantation. UROLOGY 70: 659 – 661, 2007. © 2007 Elsevier Inc. T he most common complications after kidney transplantation are urinary tract obstructions due to stenosis, lymphocele, and clotting. Lymphoce- les are extraperitoneal lymphatic collections usually lo- cated between the transplanted kidney, the bladder, and the iliac vessels that occur in up to 16% of patients after kidney transplantation. 1 Most lymphoceles are asymp- tomatic and go unnoticed, especially when small. Lym- phatic collections that are larger or located close to the ureter can become clinically manifest, usually 18 to 180 days after transplantation. 2 Depending on the size and location, lymphoceles can cause edema of the ipsilateral leg, deep venous thrombosis, bladder displacement, and ureteral obstruction, resulting in transplant malfunction. Management of symptomatic lymphoceles is still contro- versial. Simple needle aspiration and percutaneous exter- nal drainage, with or without the injection of sclerosing solutions, are less-invasive alternatives to surgery; how- ever, they are fraught with high recurrence and compli- cation rates. 3,4 Open or laparoscopic intraperitoneal mar- supialization of the lymphocele is usually recognized as the treatment of choice but require hospitalization, gen- eral anesthesia, and, sometimes, extensive surgical dissec- tion. 5,6 A new technique for treating symptomatic lym- phocele with a percutaneous intraperitoneal catheter has recently been described and has reportedly obtained good results. 7 We discuss our experience with this innovative percutaneous intraperitoneal drainage technique for the From the Department of Surgery and Transplantation, Udine University School of Medicine, Udine, Italy; and Department of Interventional Radiology and Division of Nephrology and Dialysis, AOSMM, Santa Maria della Misericordia Hospital, Udine, Italy Reprint requests: Gian Luigi Adani, M.D., Ph.D., Department of Surgery and Transplantation, Udine University School of Medicine, via Colugna 50, Udine 3100 Italy. E-mail: adanigl@hotmail.com Submitted: November 13, 2006; accepted (with revisions): May 17, 2007 © 2007 Elsevier Inc. 0090-4295/07/$32.00 659 All Rights Reserved doi:10.1016/j.urology.2007.05.018