Complications and precautions of sclerotherapy for chyluria

Abstract

Chyluria is a debilitating illness seen in 1-2% of patients of filariasis after 10-20 years of initial infection. The obstructed retroperitoneal lymphatics rupture into pelvicalyceal system and leads to patient passing milky white chylous urine with haematuria and chylous clots. Sclerotherapy as a minimally invasive treatment modality has been used for last 35 years. Hypertonic saline, hypertonic glucose, contrast (15-25% Na iodide and Na diatrizoate), silver nitrate (0.1, 0.5, 1, 3, and 5%) and povidone-iodine (0.2%) have all been used as sclerosants with varying results. The various complications and lessons learned due to the most widely used sclerosant, silver nitrate, have been discussed in detail. The prerequisites and precautions, both preoperative and intraoperative, especially when using 1% silver nitrate instillations for sclerotherapy have been outlined to make it a safe, effective and minimally invasive treatment for chyluria.

Keywords

• Chyluria; Complications; Sclerotherapy