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

Murthy, Kolar; Reddy, S. Jayaram; Prasad, Dinesh; Purusotham, G.

doi:10.1159/000288233

Cited by 8 publications

(6 citation statements)

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“…Traditional instillation protocol is 8 hourly for 3 days with total nine doses. [ 7 28 ] There are some studies show that three doses may have similar efficacy to that with nine doses. [ 29 ] Sparse data also suggest that even single dose may have similar efficacy, but these studies have not mentioned the outcomes according to grade or severity of disease.…”

Section: Discussionmentioning

confidence: 99%

Are there any factors affecting the outcome of endoscopic sclerotherapy in filarial chyluria? A prospective study

et al. 2017

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Introduction:Filarial chyluria is a frequent problem in India. While endoscopic therapy is the mainstay of treatment, it is not always successful. We aimed to determine parameters that affect outcomes of endoscopic sclerotherapy for filarial chyluria (FC).Methods:Prospectively maintained data of FC patients who received endoscopic sclerotherapy between June 2011 and March 2015 were analyzed. Sclerotherapy included either povidone-iodine (0.1%) or silver nitrate (1%). The parameters recorded included clinical evaluation, urinary triglyceride (TG)/cholesterol, sclerotherapy treatment, and follow-up.Results:One hundred and fifty-seven patients (male: female, 104:53) with a mean age (± standard deviation [SD]) 41.12 ± 13.68 years underwent endoscopic sclerotherapy. Grade II (68.88%) chyluria was a most common presentation followed by Grade III (25.69%). One hundred and forty-four patients responded whereas six patients failed to respond; another seven were lost to follow up, and twenty patients had recurrence. Overall success rate was 86.11%. Baseline urinary TG (mean ± SD) between success and recurrence group was 195.51 ± 164.73 mg/dl and 652.65 ± 62.55 mg/dl and cholesterol (mean ± SD) was 16.99 ± 10.08 mg/dl and 89.07 ± 39.87 mg/dl, respectively. Patient with urinary TGs >300 mg/dl and urinary cholesterol >30 mg/dl had 3.2 and 1.3 times higher chance to have recurrence after endoscopic sclerotherapy, respectively. Choice of sclerosing agent (silver nitrate 1% versus povidone-iodine 0.1%) had no difference in success rate, but silver nitrate had slightly higher complications rate (25% vs. 20%). A higher number of instillations (>3) was associated with better success rate. Majority of the complications were either Clavien Grade 1 or 2.Conclusions:The factors predicting recurrence were higher clinical grade, higher number of pretreatment courses, and high urinary TG and cholesterol.

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Section: Discussionmentioning

confidence: 99%

Are there any factors affecting the outcome of endoscopic sclerotherapy in filarial chyluria? A prospective study

et al. 2017

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“…Many authors have described the use of PI as a sclerosing agent in the treatment of chyluria due to its high efficacy, antibacterial properties, availability, and minimal side-effects [1] , [7] , [8] . Many studies have used PI as a sclerosing agent for the treatment of chyluria either in isolation or in combination with other agents, and also either as a single or multiple instillation [5] , [8] , [15] . Yet, no definite standard protocol exists for describing the optimum dose, duration, and number of instillation.…”

Section: Discussionmentioning

confidence: 99%

“…They had five patients with recurrence, one after 1 month, two after 3 months and two after 6 months. Murthy et al [15] used nine instillations of PI 0.2%, and reported a success rate of 81%. They had recurrence after 1 month in four patients and repeated the instillation with complete clearance in two of these four patients.…”

Section: Discussionmentioning

confidence: 99%

Single versus multiple instillation of povidone iodine and urographin in the treatment of chyluria: A prospective randomised study

Seleem

Eliwa

Elsayed

et al. 2016

Arab Journal of Urology

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ObjectiveTo compare the safety, efficacy and complications of single vs multiple instillations of povidone iodine (PI) and urographin as a sclerosing agent in the treatment of chyluria.Patients and methodsThe study included 58 patients diagnosed with chyluria between March 2006 and January 2013. The inclusion criteria were either severe attacks of chyluria or patients with mild-to-moderate chyluria who had failed conservative treatment. The patients were randomly allocated to one of two groups: those in Group A had a single instillation of a combination of PI 0.2% plus the contrast-agent urographin 76%, while those in Group B had multiple instillations of the same combination twice daily for 3 successive days.ResultsThe mean (SD) age of the patients in Groups A and B was 38.22 (10.67) and 37.9 (10.86) years, respectively. Chyluria was severe in eight patients (14.8%), moderate in 25 (46.3%) and mild in 21 (38.9%). The success rate in Group A (single instillation) was 85.2% and in Group B (multiple instillation) was 88.9%. The recurrence rate in Group A was 14.8% with a disease-free duration (DFD) of 4–15 weeks, while in group B it was 11.1% with a DFD of 6–18 weeks.ConclusionThere was no significant difference between a single instillation of a combination of PI 0.2% and urographin 76% as a sclerosing agent in the treatment of chyluria and multiple instillations. However, the single instillation protocol is more cost effective with a shorter hospital stay.

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“…[12] Many of the other studies do exist to mention the efficacy of povidone iodine as an effective sclerosant. [13]…”

Section: Discussionmentioning

confidence: 99%

Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study

et al. 2014

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Background:Milky urine can be due to chyluria or lipiduria due to nephrotic syndrome. Filarial chyluria usually responds to medical management while non-filarial cases may require surgical intervention.Aim:To perform a prospective observational study in patients presenting with milky urine in our centre over a period of one year from July 2011 to June 2012, a complete biochemical work up and imaging to find out the site of leakage of lymph if it is a case of chyluria, its response to medical management and the requirement of surgical intervention.Materials and Methods:Routine blood and urine investigations, 24 hour urine protein excretion, USG abdomen, serum lipid profile and rapid filarial antigen test were done in all. MRI abdomen was done in affordable patients. Renal biopsy was done in some chyluria patients for academic purpose and in milky urine with negative urine ether test. Sclerotherapy was done with 50% dextrose and 0.2% povidone iodine. Patients were followed up with 24 hour urine protein and triglyceride estimation.Results:18 cases of milky urine were encountered. 8 were filarial chyluria, 9 non- filarial and 1 MCD. Mean urine TG level and median 24 hour urinary protein excretion were 37.2 ± 24.6 mg% and 4.96 g respectively. The mean age for filariasis (22.9 ± 4.5 years) was significantly different from that of non-filarial etiology (31.5 ± 4.8 years) (P = 0.005). The mean 24 hour urinary protein for normal MRI cases (4.64 ± 0.70 g) was significantly different from those with dilated lymphatics (8.15 ± 2.55 g) (P = 0.02). All the non- filarial and 4 filarial cases required sclerotherapy. One patient required a second sitting.Conclusion:Milky urine is most commonly due to chyluria and occasionally due to nephrotic syndrome. Nephrotic syndrome is managed in its own way while chyluria not amenable to pharmacological intervention is managed with sclerotherapy.

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

Cited by 8 publications

References 35 publications

Are there any factors affecting the outcome of endoscopic sclerotherapy in filarial chyluria? A prospective study

Are there any factors affecting the outcome of endoscopic sclerotherapy in filarial chyluria? A prospective study

Single versus multiple instillation of povidone iodine and urographin in the treatment of chyluria: A prospective randomised study

Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study

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