Instillation of Silver Nitrate in the Treatment of Chyluria

Sabnis, Ravindra; Punekar, Sulabha; Desai, Roshani; Bradoo, Anil; Bapat, Supriya

doi:10.1111/j.1464-410x.1992.tb15839.x

Cited by 45 publications

(42 citation statements)

References 12 publications

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“…3,10 Other invasive treatments include laser cauterization, povidone-iodine or silver nitrate sclerotherapy, laparoscopic renal pedicle lymphatic disconnection or even autotransplantation. 7,[15][16][17][18][19][20][21] As in other previously reported cases, 6,[22][23][24] the present patient had observed by herself improvement of milky urine soon after fed on low fat meal. In patients with chyluria the urine turns cloudy and milky within 1 h and 4 h after a fatty meal.…”

Section: Discussionsupporting

confidence: 67%

Good response of low-fat/high-protein diet in a patient with chyluria

et al. 2013

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Chyluria is an inappropriate urinary excretion of chyle that turns the urine milky. A nutritional approach based on low-fat/high-protein content diet associated or not with medium-chain triglyceride (MCT) showed to be an efficient conservative treatment to improve the milky urine appearance in a patient with chyluria. Case report: A 30-year-old female patient was admitted with chyluria of unknown etiology. An ureteropyeloscopy revealed a single lesion in each kidney, both with linear aspect and measuring 5 mm in extension. These lesions were located close to the renal papillae and were leaking a cloudy and milky fluid. Both lesions were laser cauterized followed by improvement of the milky urine. However, the chyluria relapsed after few months and a low-fat/high-protein content diet with 10 g of soybean oil to meet the requirements essential fatty acids (EFA) and with MCT from coconut oil as alternative to prepare foods was started. Few weeks later the patient returned reporting consistent improvement of the milky urine appearance related with the use of the diet. However since the diet was tasteless and time consuming to prepare, she reported low compliance to diet with MCT and the milky urine relapsed. The MCT was discontinued and the diet with EFA source was maintained with better compliance. Since then the chyluria remains in remission. In conclusion, the dramatic improvement of the milky urine with low-fat/high-protein diet with EFA source observed in our patient demonstrates that this nutritional approach is efficient with fast results to treat chyluria during long term.

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Section: Discussionsupporting

confidence: 67%

Good response of low-fat/high-protein diet in a patient with chyluria

et al. 2013

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“…Later fibrosis and blockage of lymphatics occur, leading to closure of lymphatic pelvic communication [20] . In the past, silver nitrate as a sclerosant was commonly used in concentration ranging from 0.1-3% [21,22] . Although it was effective in 80% of the cases, it was not without complications.…”

Section: Discussionmentioning

confidence: 99%

Povidone Iodine Instillation into the Renal Pelvis in the Management of Chyluria: Our Experience

Murthy¹,

Reddy²,

Prasad³

et al. 2010

Urol Int

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Purpose: We report our experience with the use of povidone iodine instillation into the renal pelvis for the treatment of chyluria. Materials and Methods: From August 2006 to November 2008, 26 patients with chyluria were treated. There were 18 males and 8 females ranging from 24–55 years of age. Cystoscopic localization of chylous efflux was done. Povidone iodine as a sclerosing agent was instilled through a ureteric catheter placed in the renal pelvis. A total of 9 doses were given at 8-hour intervals for 3 days. Unilateral instillation was done in 20 cases, and bilateral instillation was done in 6 patients. Results: Twenty-one of 26 patients showed complete clearance. In 4 patients, recurrence was noted and a repeat injection was given after 4 weeks, with success, in 2 patients. The other two patients required chylolymphatic disconnection. One patient was lost to follow-up. Conclusion: Our experience shows that povidone iodine is a safe and effective sclerosing agent in the management of chyluria.

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“…It is a water insoluble compound. These problems have led to a decrease in its use 12. One death after bilateral instillation has been reported 13…”

Section: Global Health Problem Analysismentioning

confidence: 99%

Chyluria: a scourge of our region

et al. 2015

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Chyluria is endemic in the Gangetic belt of India with an average of 90 cases treated annually at our institute. It is almost exclusively caused by Wuchereria bancrofti in tropical areas. Chylomicrons and triglycerides are lost in the urine from an abnormal lymphourinary fistula due to obstructive lymphatic stasis, most commonly at the renal pelvis. It is a distressingly recurrent condition with multiple exacerbations and remissions over years. Severe weakness, weight loss and haematuria occur in some patients. Diagnosis can be made by visual examination of milky urine along with the ether test of urine for chylomicrons. Intravenous urography is used to locate the site of the fistula, although the detection rate is poor. Treatment starts with conservative measures such as a high-protein low-fat diet and diethylcarbamazine therapy. In cases where conservative measures fail, endoscopic sclerotherapy (renal pelvic instillation of silver nitrate, povidone iodine or others) and surgical therapy are used.

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Instillation of Silver Nitrate in the Treatment of Chyluria

Cited by 45 publications

References 12 publications

Good response of low-fat/high-protein diet in a patient with chyluria

Good response of low-fat/high-protein diet in a patient with chyluria

Povidone Iodine Instillation into the Renal Pelvis in the Management of Chyluria: Our Experience

Chyluria: a scourge of our region

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