Abstract
INTRODUCTION: Chyluria is a rare condition characterized by milky urine usually occurring due to rupture of lymphatic channels into the urinary system. Common symptoms include milky urine, clot colic, urinary retention, weight loss, edema, etc. Diagnosis is based on clinical suspicion, laboratory tests and imaging techniques such as USG, CT, MRI, and lymphangioscintigraphy. Management is based on dietary modifications, pharmacological treatment, minimally invasive endoscopic sclerotherapy, and laparoscopic chylolymphatic disconnection. Other procedures such as lymphovenous anastomosis or simple nephrectomy can also be adapted. CASE DESCRIPTION: A 33-year-old female from a filariasis endemic region of Nepal presented with chief complaints of whitish urine for 15 months associated with weight loss. The patient was initially treated with diethylcarbamazine (DEC) for 21 days, a year ago with some dietary modifications. She also underwent two episodes of endoscopic sclerosant instillations. The immunochromatographic test for filariasis was positive. Milky efflux was seen from the left ureteric orifice. Retrograde pyelography showed lymphatic backflow. The patient was managed with laparoscopic left chylolymphatic disconnection (Hilar stripping and nephron lympholysis), and the symptoms resolved. DISCUSSION: Refractory cases of chyluria require surgical intervention to prevent long-term morbidity. Traditional open surgical ligation and excision of renal pedicle lymphatics are replaced by the minimally invasive approach of retroperitoneoscopy. The laparoscopic method is a preferred treatment as it has minimal incision-related morbidity and is safe, effective, and efficient. Other surgical options include lymphovenous anastomosis or renal autotransplantation. CONCLUSION: This case highlights the success of surgical intervention in treating refractory chyluria. Chylolymphatic disconnection could be safely performed with a laparoscopic approach without significant complications and reoccurrence.