Chyluria is secondary to the presence of chyle in the urine. The classical appearance on inspection is of milky white urine, which is caused by a fistulous communication between the lymphatic system and the urinary tract. Worldwide, it is most commonly associated with the parasite Wuchereria bancrofti, which is prevalent in Asia, most extensively in India but also China and Taiwan. However, in the United Kingdom, Europe and North America, where the condition is rare, non-parasitic aetiologies predominate. Chyluria is occasionally associated with other urinary tract symptoms including infection, loin pain and haematuria. It may also cause hypoproteinaemia, weight loss and cachexia. Management is based on identifying the aetiology and depends on the severity of the chyluria and presence of associated symptoms. Given its predominate symptom being urinary, cases in the West can fall under the care of the urologist. The aim of this article is to provide an overview and summary of the aetiology, assessment and management of chyluria based on the most up-to-date evidence available. This was achieved through a non-systematic review of world literature.
DESCRIPTIONAn 81-year-old woman who had a long-term silicone suprapubic catheter (SPC) presented to hospital-few hours following a routine change of the catheter in the community-reporting drainage of a faeculent matter. The patient was clinically well. A suspicion of a colovesical fistula was raised and a CT scan of the abdomen and pelvis was carried out. The latter showed that the SPC was situated entirely outside the bladder with the tip of the catheter located inside the descending colon (figures 1 and 2). Studying the CT scan images it became apparent that the catheter had not entered the bladder's cavity but rather it had eroded its way around the bladder and perforated the descending colon.The fact that the patient had no symptoms weighed heavily into our decision to manage the patient conservatively. A urethral catheter was inserted and the SPC was left in situ for 2 weeks. Subsequently, the SPC was removed and the patient remained well. Four weeks later she underwent a repeat CT scan. This did not show any obvious malignancy or fistula; however, it showed that the sigmoid colon is in close proximity to the anterolateral wall of the bladder (figures 3 and 4).Searching the literature we identified two similar case reports, 1 2 in which we agree with the authors' conclusion that viscus perforation is more likely to occur when the catheter material is not soft as demonstrated in this case, also patients with chronic inflammatory conditions such as UTIs, or diverticulitis are at higher risk of viscus injury. Learning points▸ Bowel injury is a recognised complication of suprapubic catheter (SPC) insertion, this could happen at the time of first insertion or during a routine change of the catheter. Risk factors for viscus injury are rigid catheters and chronic inflammatory conditions. ▸ Bowel injury could be occult and the patient remains asymptomatic despite a significant injury. ▸ There is a place for a conservative management of bowel injury secondary to SPC insertion depending on the individual patient.Competing interests None.Patient consent Obtained.
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