Is single dose povidone iodine sclerotherapy effective in chyluria?

Chyluria is a chronic debilitating condition characterized by formation of pyelo-lymphatic connections. Renal pelvic instillation sclerotherapy is a minimally invasive treatment modality in treatment of chyluria. Various sclerosant with different regimen have been described in literature but there is no single consensus on this regard.

To evaluate the effectiveness and safety of single dose 0.2% povidone iodine renal pelvic instillation sclerotherapy for the treatment of chyluria.

In a prospective study from August 2010 till July 2013, forty one patients presenting with milky urine were included. Apart from ether test, presence of lymphocytes in urine and urine triglycerides levels were also done to confirm chyluria. On a day care basis under local anesthesia 5F open ended ureteric catheter was introduced in the ureteric orifice of affected side. Freshly prepared 7-10 ml of 0.2% povidone iodine solution was instilled with the patient in Trendelenburg position.

Total of 41 patients were enrolled ( 27 males and 14 females; mean age 40 years, SD 8.9, range 19-61) with a mean follow up of 20 months. Immediate clearance was seen in all patients and recurrence in 7 (17%). Mean disease free duration was 18 months. Two patients had moderate to severe flank pain.

Single dose 0.2% povidone iodine sclerotherapy is safe and effective treatment for chyluria. As it offers treatment on a day care basis, continuous ureteral and urethral catheterizations can be avoided.