Chyluria: what does the clinician need to know?

Chyluria is secondary to the presence of chyle in the urine. The classical appearance on inspection is of milky white urine, which is caused by a fistulous communication between the lymphatic system and the urinary tract. Worldwide, it is most commonly associated with the parasite Wuchereria bancrofti, which is prevalent in Asia, most extensively in India but also China and Taiwan. However, in the United Kingdom, Europe and North America, where the condition is rare, non-parasitic aetiologies predominate. Chyluria is occasionally associated with other urinary tract symptoms including infection, loin pain and haematuria. It may also cause hypoproteinaemia, weight loss and cachexia. Management is based on identifying the aetiology and depends on the severity of the chyluria and presence of associated symptoms. Given its predominate symptom being urinary, cases in the West can fall under the care of the urologist. The aim of this article is to provide an overview and summary of the aetiology, assessment and management of chyluria based on the most up-to-date evidence available. This was achieved through a non-systematic review of world literature.

The Use of Cook Resonance Metallic Ureteral Stent in Cases of Obstructive Uropathy from Persistent Neoureteral Stenosis, Following Kidney Transplantation.

Introduction: Following kidney transplantation, persistent cases of obstructive uropathy from neoureteral stenosis, at the reimplantation site, may require management with permanent, long-term Double-J stenting, following failed open surgical and minimally invasive procedures. We report our experience of the use of Cook Resonance® metallic ureteral stent to manage such cases endourologically. Materials and Methods: Medium-term follow-up of two cases requiring long-term ureteral stenting. Medical records, operative details, and radiologic data were reviewed. Primary outcome was relief of obstructive uropathy, and secondary outcomes included clinicoradiologic complications and cost-effectiveness of the metallic stents compared with standard Double-J stents. Results: Case 1 was a 45-year-old lady with obstructive uropathy after kidney transplantation. To date, she has had four metallic stents, and on review of operative details and radiologic data, there was seen to be a 60% reduction in operation length from the first to fourth stent exchange. Radiation dose exposure saw an 80% reduction from 2852 to 556 CGy·cm2. Following 3 years of follow-up, relief of obstructive uropathy has been maintained, with no radiologic or clinical evidence of complications. Case 2 was a 44-year-old lady with obstructive nephropathy requiring long-term stenting after kidney transplantation. Two stent exchanges have been performed to date with a 38% reduction in operation length from 50 minutes to just 31 minutes. Radiation dose exposure saw a 41% reduction. No clinicoradiologic complications or stent-related symptoms have occurred. Discussion: In our experience, use of metallic stents in transplanted kidneys is safe and feasible, with both patients having effective and sustained relief of obstructive uropathy. This stent appears to be well tolerated and is associated with minimal clinicoradiologic complications. Metallic stent replacement is also cost-effective due to the fact that it only requires annual rather than 6-monthly stent changes.

Urolift - minimally invasive surgical BPH management.

INTRODUCTION: An ideal treatment option for symptomatic Benign Prostatic Hyperplasia (BPH) should relieve lower urinary tract symptoms (LUTS) and restore Quality of Life (QoL). Currently available medical therapies and surgical options for symptomatic BPH have side effects that adversely affects quality of life. Prostatic urethral lift (PUL) is a novel endourology procedure that promises to relieve LUTS without the aforementioned side effects. Areas covered: We diligently reviewed all the published literature on PUL, till July 2016 using standard search criteria. Expert commentary: There is good quality evidence to establish the efficiency of PUL in treating symptomatic BPH without adversely affecting the QoL. Based on the current literature, PUL can be considered as an option for those symptomatic BPH patients with small or medium size prostates (< 80 ml) without median lobe enlargement, who failed on medical therapy or are intolerant to it and wish to preserve their sexual function.