Endoscopic treatment of chyluria using povidone Iodine with contrast agent : a preliminary experience

ABSTRACT

Objective: To evaluate the safety and efficacy of povidone iodine with contrast agent as a sclerosant for the endoscopic treatment of chyluria. Patients and Methods: From December 1999 to October 2003; a total of 22 patients having chyluria were treated. After their baseline evaluation they were subjected to endoscopic instillation therapy. The scleros-ing agent was prepared by using povidone iodine with contrast agent diluted with sterile water in the ratio of 113. The side with chylous efflux was identified via cysto-scopy. Using a bulb tip ureteric catheter the sclerosing solution was instilled in the pelvicalyceal system. Unilateral instillation was performed in 13 cases; eight on the left and five on the right side. In the remaining nine cases that had bilateral chylous efflux instillation was performed on both sides in the same session. Fluoroscopy was used to see the complete filling of the pelvicalyceal system. The sclerosing solution was kept in the system for five minutes and the ureteric catheter was then withdrawn. Results: All patients were cured from chyluria in the immediate post operative period. Relapse occurred in three patients; but retreatment by instillation therapy resulted in cessation of chyluria also in these cases. The longest follow up was three years; the shortest two months. Fifteen patients were lost to follow up after nine months. None of the cases but the three mentioned previously had relapse during the follow-up period. Conclusion: Povidone iodine is a very safe and efficacious agent for the endoscopic treatment of chyluria by instillation therapy. Using a contrast agent along with it helps to know; under fluoroscopic guidance; the exact amount of sclerosing agent to be instilled to completely fill the pelvicalyceal system. Thus overfilling of the system is avoided and the complications occurring due to pyelointerstitial backflow of the sclerosant are prevented