One hundred and sixty-one cases of chyluria have been studied. The possible aetiological factors, the approach to investigation and the methods and results of treatment have been discussed. In this series, the diagnosis was established by the presence of chyle in the urine. Lymphography was carried out in 90 patients for the localisation of the site of lymphatic reflux while cystoscopic examination after fatty meal was useful in determining the side with the heavier leakage. One hundred and nineteen cases responded to conservative treatment and only 42 cases required operative treatment. Stripping of the renal pedicle via the retroperitoneal route gave the best results.
While performing a colocystoplasty for cancer of the urinary bladder, we found that the stomach was low-lying and that the pylorus could reach the pelvis with ease. It then occurred to us that the pyloric portion of the stomach could be used to replace the urinary bladder, after which the duodenum could be anastomosed to the divided urethra. As we were not certain whether this operation would he feasible, we studied it in dogs. Technically it was difficult, but after losing some dogs we managed to succeed in performing the operation and grafted a pyloric portion of the stomach to the urethra of the dogs. A study was made on both the function of this new bladder and the gastric secretion. After two years we were quite satisfied that the gastric pouch would serve as a urinary bladder and that there was no hyperchlorcaemic acidosis in these dogs.
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