Chyluria in Pregnancy-A Decade of Experience in a Single Tertiary Care Hospital

BACKGROUND Chyluria i.e. passage of chyle in urine, giving it milky appearance, is common in many parts of India but rare in west. Very few case of chyluria in pregnant female has been reported in literature. Persistence of this condition may have deleterious effects on health of child and mother. In the present study 43 cases of chyluria during pregnancy and their management seen over a period more than 10 years have been presented. OBJECTIVES The study aims to present our experience of managing 43 cases with chyluria during pregnancy over a period of ten years from July 2003 to June 2014. PATIENTS AND METHODS Forty three pregnant patients with chyluria, who presented between July 2003 to June 2014 to the department of Urology, Indira Gandhi Institute of Medical Sciences, Patna were included. Patients underwent conservative management and/or sclerotherapy after evaluation. Follow-up of all patients was done by observation of urine color, routine examination of urine and test for post prandial chyle in urine up to 3 months after delivery. RESULTS Conservative management by dietary restriction of fat and physical rest was successful in six patients. Thirteen patients improved after first course of sclerotherapy with 10% povidone iodine and 25% dextrose and 19 patients improve after second session. In non-responders, three patients who were near term underwent caesarian section while two patients opted for medical termination of pregnancy at their own will. After sclerotherapy, minor complications like clot retention, fever, hematuria, and abdominal pain were observed in small number of patients and managed symptomatically. CONCLUSIONS Sclerotherapy for symptomatic relief of chyluria during pregnancy showed high response rate (86.2%) in short term follow-up. Sclerotherapy with 10% povidone iodine and 25% dextrose combination have been proved safe and effective during pregnancy. Medical termination of pregnancy and cesarean section (those near term) may be the options in resistant cases not responding to sclerotherapy.