Purkait Bimalesh, Goel Apul, Garg Yogesh, Pant Shriya, Singh Bhupendra Pal, Sankhwar Satya Narayan
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Indian J Urol. 2017 Oct-Dec;33(4):294-299. doi: 10.4103/iju.IJU_77_17.
Filarial chyluria is a frequent problem in India. While endoscopic therapy is the mainstay of treatment, it is not always successful. We aimed to determine parameters that affect outcomes of endoscopic sclerotherapy for filarial chyluria (FC).
Prospectively maintained data of FC patients who received endoscopic sclerotherapy between June 2011 and March 2015 were analyzed. Sclerotherapy included either povidone-iodine (0.1%) or silver nitrate (1%). The parameters recorded included clinical evaluation, urinary triglyceride (TG)/cholesterol, sclerotherapy treatment, and follow-up.
One hundred and fifty-seven patients (male: female, 104:53) with a mean age (± standard deviation [SD]) 41.12 ± 13.68 years underwent endoscopic sclerotherapy. Grade II (68.88%) chyluria was a most common presentation followed by Grade III (25.69%). One hundred and forty-four patients responded whereas six patients failed to respond; another seven were lost to follow up, and twenty patients had recurrence. Overall success rate was 86.11%. Baseline urinary TG (mean ± SD) between success and recurrence group was 195.51 ± 164.73 mg/dl and 652.65 ± 62.55 mg/dl and cholesterol (mean ± SD) was 16.99 ± 10.08 mg/dl and 89.07 ± 39.87 mg/dl, respectively. Patient with urinary TGs >300 mg/dl and urinary cholesterol >30 mg/dl had 3.2 and 1.3 times higher chance to have recurrence after endoscopic sclerotherapy, respectively. Choice of sclerosing agent (silver nitrate 1% versus povidone-iodine 0.1%) had no difference in success rate, but silver nitrate had slightly higher complications rate (25% vs. 20%). A higher number of instillations (>3) was associated with better success rate. Majority of the complications were either Clavien Grade 1 or 2.
The factors predicting recurrence were higher clinical grade, higher number of pretreatment courses, and high urinary TG and cholesterol.
丝虫性乳糜尿在印度是一个常见问题。虽然内镜治疗是主要的治疗方法，但并非总是成功。我们旨在确定影响丝虫性乳糜尿（FC）内镜硬化治疗效果的参数。
对2011年6月至2015年3月期间接受内镜硬化治疗的FC患者的前瞻性数据进行分析。硬化治疗包括使用聚维酮碘（0.1%）或硝酸银（1%）。记录的参数包括临床评估、尿甘油三酯（TG）/胆固醇、硬化治疗及随访情况。
157例患者（男∶女 = 104∶53）接受了内镜硬化治疗，平均年龄（±标准差[SD]）为41.12±13.68岁。Ⅱ级（68.88%）乳糜尿最为常见，其次是Ⅲ级（25.69%）。144例患者有反应，6例患者无反应；另有7例失访，20例复发。总体成功率为86.11%。成功组与复发组的基线尿TG（均值±SD）分别为195.51±164.73mg/dl和652.65±62.55mg/dl，胆固醇（均值±SD）分别为16.99±10.08mg/dl和89.07±39.87mg/dl。尿TG>300mg/dl和尿胆固醇>30mg/dl的患者在内镜硬化治疗后复发的几率分别高3.2倍和1.3倍。硬化剂的选择（1%硝酸银与0.1%聚维酮碘）在成功率上无差异，但硝酸银的并发症发生率略高（25%对20%）。灌注次数较多（>3次）与较高的成功率相关。大多数并发症为Clavien 1级或2级。
预测复发的因素包括临床分级较高、预处理疗程数较多以及尿TG和胆固醇水平较高。
