Milky White Urine After Relief of Urinary Retention

Abstract

Background: Chyluria is a rare condition where chyle is excreted into the urine. Clinically, most patients manifest with intermittent passage of milky urine. Patients may also present with dysuria, urinary frequency, urgency, retention, or with the sequelae of chronic malnutrition. Case Report: We present a 55-year-old African American man who presented to the emergency department complaining of milky white urine, dysuria, decreased urine output, and suprapubic abdominal pain once a day. Why Should an Emergency Physician Be Aware of This?: Patients may present to the emergency department complaining of milk-colored urine, hematuria, urinary retention, or the sequelae of malnutrition. Initial evaluations should include laboratory investigations of common causes of chyluria and the severity of the potential malnutrition. If the patient presents with urinary retention, after relieving the obstruction in the emergency department, assessment for clot/chyle burden and likelihood of recurrence of urinary retention should be performed by urology. Arrangements for proper outpatient follow-up should be made if the disease manifestations are not severe enough to warrant admission.

Renal pedicle lymphatic ligation for non-parasitic chyluria via retroperitoneal laparoscopic surgery: a single-center 12-year experience

“…Due to a large loss of protein and fat in the urine, non-parasitic chyluria patients often present with hypoproteinemia, malabsorption, general fatigue, and weight loss. In addition, some patients may experience ipsilateral flank pain, frequent urination, urinary tract infection, and urinary retention symptoms ( 15 , 17 , 18 ). Up to now, targeted treatments for chyluria mainly include conservative treatments and surgery.…”

Unusual case of recurrent urinary retention – A rare presentation of Chyluria

“…There are limited number of case reports where patient presented with retention and weakness, but they usually have a associated history of passing milky urine. 3 Once the lymph channels are blocked, one of them may open into the kidney hilum or ureter or sometimes into the bladder and chyle can leak into the urinary tract resulting in milky white urine. Blood sometimes mixes with the urine resulting in haemato-chyluria.…”

“… 1 , 2 Retention as the only presentation is very rare and gives a diagnostic dilemma in elderly male. 3 After drainage of urine, assessment of clots and possibility of recurrent retention has to be explained. Sudden presentation is uncommon and there is usually a long history of passing milky urine.…”

Management of chyluria using percutaneous thoracic duct stenting

“…Chyluria is divided into parasitic and non-parasitic categories (Stainer et al 2020 ). Non-parasitic chyluria is a rare condition and caused by: trauma, surgery, infections, malignancy, lymphatic malformation, radiation, urinary retention, congenital fistula between lymphatics and the urinary tract, pregnancy and stenosis of the thoracic duct (TD) (Stainer et al 2020 ; Shah et al 2020 ). There are no guidelines for the management of chyluria.…”