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anybody else have a lymphocele pop up in a critical area after RPLND surgery?

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  • anybody else have a lymphocele pop up in a critical area after RPLND surgery?

    I did.

    Had my 4 month post-op visit to Sloan-Kettering last Thursday, and we quickly found out why my creatinine numbers were high the past few months (1.7-1.9, normal is 0.7-1.1 I think).

    The CT scan showed that I had a 4-5cm lympocele adjacent to the ureter of my left kidney and pressing into it, delaying drainage from it probably by quite a bit and causing hydronephrosis. Lovely. Dr. Sheinfeld explained that it's not uncommon to see these, and as long as they're small enough or not impacting anything they let them go all the time, but this was pretty clearly stopping up my left kidney so really needed to come out. Dr. S was awesome, explained things really well, made a couple of calls for us, and was able to get me into an add-on slot for the interventional radiologist same day while we were in town. As soon as I was done seeing Dr. Bosl (he fired me, "why are you here?" ), my wife and I headed over to the Same Day Hospital (SDH) which was a block or two away and started getting prepped for the out-patient procedure/surgery.

    IV line in, put me on my stomach on a big table, stuck me in another CT scan machine, sharpied up my back a bit, put me under moderate sedation, and then proceded to stick a big ol needle right through my flinchy lower left back muscle to get at this thing and drain it for awhile. They said they pulled out about 100cc of fluid which is consistent with what they'd expect from its size, and then hopefully sealed it off by creating an inflammation in the area with 100% alcohol. They had me switch sides from front, right side, and left side every 15 minutes to help inflame the whole area to increase the chances of everything getting sealed off. Confirmed with my wife and the procedure was "fine needle aspiration with catheter placement and alcohol sclerosis".

    The whole thing wasn't too painful, about like getting a Mediport put in or taken out, minus the part where they pulled out the catherter which was done after the sedation was wearing off, so hurt quite a bit but only for a few seconds. That back muscle they went through wasn't very happy afterwards though, and the lousy beds at the Helmsley Medical Towers didn't help either. My wife and I were both happy that we were able to get this all done in a single day though. Was our 7 year wedding anniversary this weekend so we had other plans too, and fortunately didn't have to deviate from our schedule too much.

    Getting a nuclear medicine kidney scan done locally here in DC on the 24th now to reassess, and hopefully (fingers crossed, knocking on wood) everything will come out normal. Fun fun fuuunnnnn.... (not) But at least Dr. Bosl fired me and said he really didn't need to see me anymore.
    Young Adult Cancer Survivorship by Steve Pake
    April is Testicular Cancer Awareness Month!
    www.stevepake.com
    Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
    My Survivorship Thread | All of my Blogs
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  • #2
    Yes, I had a lymphocele, but that was after my hydrocelectomy.
    It was re-absorbed over time and did not require anything more than anxious surveillance.

    Originally posted by S P View Post
    They said they pulled out about 100cc of fluid which is consistent with what they'd expect from its size,
    Did you get a cytology report on the fluid?
    Stage III. Embryonal Carcinoma, Mature Teratoma, Choriocarcinoma.
    Diagnosed 4/19/06, Right I/O 4/21/06, RPLND 6/21/06, 4xEP, All Clear 1/29/07, RPLND Incisional Hernia Surgery 11/24/08, Hydrocelectomy and Vasectomy 11/23/09.

    Please see a physician for medical advice!

    My 2013 LiveSTRONG Site
    The 2013 Already Balders

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    • #3
      Good to see you are ok though, and ughh at your mediport removal D: mine is still in and they told me it they would remove it on the year mark, which would be Feb 2012? I'm not looking up for it now
      Jan 11/2011 - left orchiectomy
      Biopsy 100% Embryonal Carcinoma
      CT Shows spread to two lynph nodes largest 5.9cm
      Jan 19/2011 Tumoral Markers lowered to almost normal levels but still high
      Staring BEPx3 on FEB 21/2011
      CT scan 5.9cm mass > 1.9cm Markers Normal
      RPLND June 30/2011 Pathologhy reports: necrotic tissue

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      • #4
        Glad they got that sorted out quickly and good to hear you got "fired"!
        Tina, wife to Gene
        Right I/O 2/21/11
        60% embryonal carcinoma- 40% seminoma with L/V invasion, Stage 1B, Cat Scan- clear
        HCG- 1.2, AFP-1.5, LDH-normal
        BEP X 2 started 3-7-11
        Bleo canceled for 2nd round, lung issues
        EP 3-28-11 X 5 days, finished chemo 4-1-11
        F/U cat scan 4/14/11 - Stable
        3rd round EP as precaution because Bleo was cancelled, start 4-25, finished chemo 4-29-11, pneumonia 5-6-11
        6-1-11, 8-3-11, 9-7-11, 10-19-11, 11-16-11, 12-18-11, 1-18-12, 5-8-12 Clear

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        • #5
          Originally posted by Already Bald View Post
          Yes, I had a lymphocele, but that was after my hydrocelectomy.
          It was re-absorbed over time and did not require anything more than anxious surveillance.

          Did you get a cytology report on the fluid?
          No I haven't, yet. What should I be looking for if anything from the cytology report? Will probably have Jose send my DC area oncologist a full report of everything after it's all written up.

          Originally posted by Evtrai View Post
          Good to see you are ok though, and ughh at your mediport removal D: mine is still in and they told me it they would remove it on the year mark, which would be Feb 2012? I'm not looking up for it now
          oh no worries! Sorry that was badly worded. I meant that the painful part was from the removal of the catheter from draining the lymphocele out. They drained it all during sedation, but still needed to soak the area with alcohol with the catheter inserted while the sedation was wearing off. Hence it hurt when they yanked it out. No worries at all on port removal. That's 100% done under sedation. I got into the operating room for the port removal and it was like as soon as they had started they were already done. They mentioned that it was so quick and painless that port removal was even doable without sedation, but I wasn't feeling particularly adventurous that day so went for the sedation anyways. I like feeling a little loopy on that stuff. LOL.

          Originally posted by MrsB View Post
          Glad they got that sorted out quickly and good to hear you got "fired"!
          Thanks! Yeah I'm sorta bummed about this complication, but I do need to look on the bright side. I got fired by Dr. Bosl, and apparently I'm not even an interesting enough case to have one of his residents examine me either. Even Dr. Sheinfeld's resident was in and out really quick? Oh this guy has been cut open already? Well that's no fun! Boooooo.
          Young Adult Cancer Survivorship by Steve Pake
          April is Testicular Cancer Awareness Month!
          www.stevepake.com
          Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
          My Survivorship Thread | All of my Blogs
          C
          ONTACT ME ANYTIME!

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          • #6
            Well this has certainly been weird, but good, and hopefully it stays that way.

            Since the RPLND, the edemic swelling in my legs never really went away completely, and especially my left leg was more prone to swelling. I could tell because the area around my ankle and the back of my foot and going up my leg a a bit has been a bit puffier than usual, and my socks left deeper impressions in my skin. Man, as soon as they uncorked my left kidney I started peeing like crazy and all of that residual edemic swelling was sucked right out of me. I probably lost another 5lbs in water weight. Legs and feet completely back to normal as of now. Had been having to get up and go way too many times at night over the past month also, but managed to only need to use the bathroom once all last night and feel very well rested for a change. Increased frequency of urination is a symptom of hydronephrosis, but you might not have any symptoms for unilateral as opposed to bilateral. Urination never really felt quite right or natural after the RPLND either, but I chalked it up to nerves being out of whack. My thighs were real tender also. It was never painful though, so I never said anything. Now urination feels a lot more "natural" and free-flowing. I think what I was feeling before was some negative pressure from that stopped up left kidney trying to suck back what was in my bladder a bit. If some of this starts to come back, I guess I'll know what to look for now.
            Young Adult Cancer Survivorship by Steve Pake
            April is Testicular Cancer Awareness Month!
            www.stevepake.com
            Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
            My Survivorship Thread | All of my Blogs
            C
            ONTACT ME ANYTIME!

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            • #7
              hey steve - well gee -- i didn't expect to hear about another PROCEDURE on your followup! but glad they got it straightened out and that everything's flowing better....also, glad it was quick and (relatively) easy... best, embee
              Nephew Will (19 years old)

              2-14-11 Left I/O; 50% EC, 40% teratoma; 10% yolk sac
              3-14-11: BEPx3
              4-18-11: Markers normalize
              6-13-11: IU pathology: 60% teratoma, 35% EC, 5% yolk sac
              7-7-11: left modified template nerve sparing RPLND at IU; 2/19 nodes with teratoma (2%), rest necrotic
              10-01-11: 1st post-RPLND TM ALL CLEAR
              12-01-11: 1st post-RPLND CT ALL CLEAR

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              • #8
                Good lord, sorry you had to go through all that, but so glad to hear it's resolved some strange outstanding issues. Now you can REALLY get back to normal
                Husband Shaun diagnosed March 2010. AFP 4571, HCG 3340.
                6cm x 6cm x 8cm retroperitoneal mass + 1cm nodule in right lung.
                Stage IIIb, Intermediate Risk.
                Left I/O March 9/10: 75% EC, 20% Teratoma, 5% Yolk Sac + Seminoma.
                3xBEP + 1xEP March 15 - May 21/10: markers normal.
                Bilateral RPLND July 28/10: 9.5 x 7 x 4.5cm mass, teratoma only.
                Chylous Ascites Aug/Sep.
                November 2012 All Clear
                Continuously monitoring 0.9 x 1.7cm omental nodule (possible fat necrosis)

                www.teamshaun.wordpress.com

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                • #9
                  Thanks, HOPING everything should be back to normal, but am not getting my hopes up just yet. There was a very subtle change in how urinating felt after they cleared this thing out, almost as if something was uncorked, but now it feels closer to how it did before. It could just be my mind playing tricks on me though. Nuclear kidney scan on Monday will hold the answers....
                  Young Adult Cancer Survivorship by Steve Pake
                  April is Testicular Cancer Awareness Month!
                  www.stevepake.com
                  Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                  My Survivorship Thread | All of my Blogs
                  C
                  ONTACT ME ANYTIME!

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                  • #10
                    UGH. Hope you are back on track now!
                    Right I/O February 2008
                    100% Seminoma
                    Surveillance
                    Two enlarged lymph nodes Feb 2011
                    4xEP final dose May 13th.

                    PET all clear June 2011
                    CT all clear October 2011

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                    • #11
                      Hey Chuck how they hanging'? Had been assuming no news equals good news with you? CT scan all clear this month? Congrats on that.

                      Kidney scan was yesterday. Hate to say but it was one of the most unpleasant procedures I've had in a long time, mostly due to the fact that it took them three tries with a big long metal catheter needle to get a good IV line going. I tried not to get too pissed off because I'm now a "hard stick" due to my veins being shot from chemo and everything, but it still hurt like hell. On top of that, when they removed the IV with me lying flat on a scan table, it started bleeding like crazy and they didn't notice for a few minutes. I didn't notice either until I felt a drip of something running down my arm. Called the tech over and got an "oh my god!". Arm a bloody mess, got all over everything, had to go home and change clothes.

                      No results yet, but I have a hunch everything is fine now. My bladder filled up so quickly after the lasix injection that it nearly burst and I could barely make it to the required time on the scan. Had to run down the hall to the bathroom after that and went for a looooong time. I don't think that would have happened if one of my kidney outputs was still obstructed. Went again before I left the hospital, and by the time I was getting home again for lunch (whopping 10 minute drive) I had to go again, a lot. LOL. Results should actually be available yesterday, so gonna call my DC oncologists' office today, and will call Dr. Sheinfeld's office also.
                      Young Adult Cancer Survivorship by Steve Pake
                      April is Testicular Cancer Awareness Month!
                      www.stevepake.com
                      Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                      My Survivorship Thread | All of my Blogs
                      C
                      ONTACT ME ANYTIME!

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                      • #12
                        Heard back from Dr. Sheinfeld's office.

                        The scan showed that the obstruction is gone, but kidney flow is split abnormally 70% right and 30% left. It should be 50/50 or at most 60/40 to be considered normal. An internal medicine / nephrologist friend of ours said that a Cr of 1.7-1.9 suggests a 40-50% reduction in renal capacity. I don't have the CT scan results that were done at Sloan, but it sounds like my left kidney output was just about completely obstructed by that lymphocele (aka hydronephrosis), and that it's flowing now but might take some more time to get back to normal.

                        So, holding pattern for now, no need for a stent since the obstruction is gone. Was told to:

                        1. Get BUN/Creatinine retested now (should be coming down to normal).
                        2. Repeat renal scan 3 weeks from 24-Oct to re-check flow, and double check that no obstruction is reforming or anything.

                        Happy birthday, please repeat that miserable renal scan. Great.

                        Will have this taken care of by my DC onco, so have been on the phone with them today trying to get things setup for the blood work and the next scan.
                        Last edited by S P; 10-27-11, 05:38 PM.
                        Young Adult Cancer Survivorship by Steve Pake
                        April is Testicular Cancer Awareness Month!
                        www.stevepake.com
                        Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                        My Survivorship Thread | All of my Blogs
                        C
                        ONTACT ME ANYTIME!

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                        • #13
                          Blood work came back from Friday. Cr now at 1.59 vs 1.7/1.9 before so things moving in the right direction.
                          Young Adult Cancer Survivorship by Steve Pake
                          April is Testicular Cancer Awareness Month!
                          www.stevepake.com
                          Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                          My Survivorship Thread | All of my Blogs
                          C
                          ONTACT ME ANYTIME!

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                          • #14
                            Wow man, at least it seems the situation is moving in the right direction. It sounds you have been in great hands at the best possible moment. Hope to have a chance to hang out again (this fall has been especially rough workwise).
                            "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
                            11.22.06 -Dx the day before Thanksgiving
                            12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

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                            • #15
                              Yeah, I need another beer or two. Let me know when. Anytime should work for me. Now that I'm off of that Lyrica, I should be able to finish hopefully TWO whole beers next time! I'm not stressing over this too much, but it's definitely been disruptive and annoying. The biggest thing is that, mentally, it's dragging me back into cancer patient land, when I'd much rather be moving on for real and forgetting all of this ever happened. Instead it's more monitoring, more scans and tests, etc... UGH! I just want to "be OK" so that doctors, all of them, can leave me the F alone.
                              Young Adult Cancer Survivorship by Steve Pake
                              April is Testicular Cancer Awareness Month!
                              www.stevepake.com
                              Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
                              My Survivorship Thread | All of my Blogs
                              C
                              ONTACT ME ANYTIME!

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