Silver nitrate sclerotherapy for 'clinically significant' chyluria: A prospective evaluation of duration of therapy

Objectives: To evaluate and compare the results of regimen A (3 instillations at 8-hourly intervals in 1 day) with the control regimen B ( 9 instillations at 8-hourly intervals in 3 days) of using 1% silver nitrate solution for renal pelvic instillation sclerotherapy in 'clinically significant' filarial chyluria. Materials and Methods: Forty-seven patients with clinically significant chyluria attending on 2 different days our urology clinic were prospectively randomized between two groups; the study group received regimen A (n = 21) while the control group received regimen B ( n = 26). The variables evaluated included visualization of pyelolymphatic fistulae on retrograde pyelography, hospital stay, outcome and morbidity of the two regimens. Results: Patients in both groups were comparable for age and sex. The morbidity ( fever, symptomatic UTI, hematuria) following regimen A was less than that of regimen B although not statistically significant. The average hospital stay was 3 days for regimen A and 5.5 days for regimen B ( p = 0.001). The initial success rate was 80.95% in group A and 92.30% in group B ( p = 0.47). The mean duration of follow-up was 15 months ( range 9 - 18). There was no significant difference in recurrence between the two groups during follow-up ( group A: 21.05% and group B: 22.72%; p = 0.98). Conclusions: Regimen A was as effective as regimen B. Regimen A had the advantages of having less morbidity and shorter duration of hospital stay. We recommend only a 3-instillation regimen in patients with clinically significant chyluria, particularly those who demonstrate pyelolymphatic fistulae on retrograde pyelography. Copyright (C) 2004 S. Karger AG, Basel.