Conservative Treatment

Conservative treatment of chyluria includes bed rest, low-fat diet (omission of long-chain triglycerides), and encouraging the use of medium-chain triglycerides (coconut oil) and high-protein diet (8). Medium-chain triglycerides (less than 12 C atoms) are transported directly from the gut to the liver via the portal system and not through the lymphatic channels, as are long-chain fatty acids. Multiple courses of antifilarial drugs are required. Other modalities of treatment include retrograde pyelography and instillation of sclerosing agents such as 10% to 25% bromide, normal saline, 0.2% povidone iodine, 50% glucose saline, or 1% to 2% silver nitrate in to the renal pelvis (12,17-19). Silver nitrate induces an inflammatory reaction in the lymphatics, resulting in chemical lymphangitis and edema of the lymph channels. Finally, fibrosis ensues causing blockage leading to immediate relief.

Retrograde pyelography and sclerotherapy have been used with a success rate varying from 55% to 68% with a recurrence rate above 50% on long-term basis (12,16,19).

A simple algorithm to treat chyluria is given in Figure 3.

FIGURE3 ■ Algorithm to treat chyluria. Abbreviations: CPE, cystoscopy; RGR retrograde pyelogram. Source: From Refs. 7,12.

FIGURE3 ■ Algorithm to treat chyluria. Abbreviations: CPE, cystoscopy; RGR retrograde pyelogram. Source: From Refs. 7,12.

Patients having persistent chyluria, clot colic, retention of urine, and weight loss despite conservative management and sclerotherapy need surgical intervention.

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