Nonsurgical management of chyluria (sclerotherapy)

Abstract

Chyluria is a chronic debilitating condition characterized by formation of pyelo-lymphatic connections. Renal pelvic instillation sclerotherapy (RPIS) is a minimally invasive treatment modality in treatment of chyluria. It involves placement of ureteric catheter under cystoscopic guidance into the pelvis of the offending renal unit and the renal pelvic capacity is measured after contrast instillation in a radiologist suite. Sclerosants acts by inducing an inflammatory reaction in the lymphatic vessels and blockade of the communicating lymphatics by fibrosis. Silver nitrate and povidone iodine are the most commonly used sclerosants in RPIS. Various protocols have been described in literature but we follow 8 h instillations (nine doses) for 3 days. Silver nitrate (0.1-1%) is effective in 60-84% of cases and povidone iodine has shown similar efficacy as silver nitrate. Patients with early recurrence after RPIS do not fare better with second-course of RPIS in comparison to the patients with delayed recurrence. Overall sclerotherapy has shown effectiveness of ~85% in curing chyluria.