The Experts below are selected from a list of 369 Experts worldwide ranked by ideXlab platform

Lionel Arrive - One of the best experts on this subject based on the ideXlab platform.

Satya Narayan Sankhwar - One of the best experts on this subject based on the ideXlab platform.

  • Chyluria in pregnancy: Etiology, diagnosis, and management perspective
    Wolters Kluwer Medknow Publications, 2019
    Co-Authors: Bimalesh Purkait, Gaurav Garg, Manmeet Singh, Ashish Sharma, Siddharth Pandey, Satya Narayan Sankhwar
    Abstract:

    Chyluria is clinically described as passage of milky urine. Chyle is absorbed by intestinal lacteals and is composed of emulsified fats, few proteins, and fibrin in varying proportions. Parasitic Chyluria is caused mainly by Wuchereria bancrofti infection. The incidence of Chyluria in pregnancy is not uncommon in endemic regions. The literature pertaining tomedical management of Chyluria in pregnancy is scant. The antifilarial drugs have potential teratogenic risk and are not recommended in pregnant patients. Hence, there is a management dilemma for managing patients with Chyluria during pregnancy. In this review, we have tried to highlight the evidence-based diagnosis and management of Chyluria in pregnancy

  • Are there any factors affecting the outcome of endoscopic sclerotherapy in filarial Chyluria? A prospective study.
    Indian journal of urology : IJU : journal of the Urological Society of India, 2017
    Co-Authors: Bimalesh Purkait, Apul Goel, Yogesh Garg, Shriya Pant, Bhupendra Pal Singh, Satya Narayan Sankhwar
    Abstract:

    Introduction: Filarial Chyluria is a frequent problem in India. While endoscopic therapy is the mainstay of treatment, it is not always successful. We aimed to determine parameters that affect outcomes of endoscopic sclerotherapy for filarial Chyluria (FC). Methods: Prospectively maintained data of FC patients who received endoscopic sclerotherapy between June 2011 and March 2015 were analyzed. Sclerotherapy included either povidone-iodine (0.1%) or silver nitrate (1%). The parameters recorded included clinical evaluation, urinary triglyceride (TG)/cholesterol, sclerotherapy treatment, and follow-up. Results: One hundred and fifty-seven patients (male: female, 104:53) with a mean age (± standard deviation [SD]) 41.12 ± 13.68 years underwent endoscopic sclerotherapy. Grade II (68.88%) Chyluria was a most common presentation followed by Grade III (25.69%). One hundred and forty-four patients responded whereas six patients failed to respond; another seven were lost to follow up, and twenty patients had recurrence. Overall success rate was 86.11%. Baseline urinary TG (mean ± SD) between success and recurrence group was 195.51 ± 164.73 mg/dl and 652.65 ± 62.55 mg/dl and cholesterol (mean ± SD) was 16.99 ± 10.08 mg/dl and 89.07 ± 39.87 mg/dl, respectively. Patient with urinary TGs >300 mg/dl and urinary cholesterol >30 mg/dl had 3.2 and 1.3 times higher chance to have recurrence after endoscopic sclerotherapy, respectively. Choice of sclerosing agent (silver nitrate 1% versus povidone-iodine 0.1%) had no difference in success rate, but silver nitrate had slightly higher complications rate (25% vs. 20%). A higher number of instillations (>3) was associated with better success rate. Majority of the complications were either Clavien Grade 1 or 2. Conclusions: The factors predicting recurrence were higher clinical grade, higher number of pretreatment courses, and high urinary TG and cholesterol.

  • Chyluria: is retrograde pyelogram mandatory prior to endoscopic sclerotherapy?
    BMJ case reports, 2014
    Co-Authors: Sagorika Paul, Manoj Kumar, Vv Singh, Satya Narayan Sankhwar
    Abstract:

    Chyluria is the passage of milky urine due to a lymphourinary fistula secondary to lymphatic stasis caused by obstruction of the lymphatic flow. This can be caused by parasitic or non-parasitic infections. Though Chyluria is a commonly encountered entity in clinical practice particularly in developing countries like India, it is rarely discussed in English literature. We report a case of Chyluria with right bifid ureter in a 50-year-old male patient who was treated with intrarenal pelvic instillation of 1% silver nitrate (AgNO3) and emphasis on the diagnostic implication of retrograde pyelography prior to endoscopic sclerotherapy in managing Chyluria particularly in renal anomalies.

  • Factors affecting response to medical management in patients of filarial Chyluria: A prospective study
    Wolters Kluwer Medknow Publications, 2014
    Co-Authors: Neeraj Kumar Goyal, Apul Goel, Bhupendra Pal Singh, Satya Narayan Sankhwar, Vishwajeet Singh, Wahid Ali, S M Natu, Rahul Janak Sinha, Divakar Dalela
    Abstract:

    Introduction: Filarial Chyluria is a common problem in filarial endemic countries. Its management begins with medical therapy but some patients progress to require surgery. The present study aimed to determine factors affecting response to medical management in patients of filarial Chyluria. Materials and Methods: This prospective study conducted between August 2008 and November 2012, included conservatively managed patients of Chyluria. Demographic profile, clinical presentation, treatment history and urinary triglycerides (TGs) and cholesterol levels at baseline were compared between the responders and non-responders. Apart from the clinical grade of Chyluria, hematuria was evaluated as an independent risk factor. Results: Out of the 222 patients (mean age, 37.99 ± 13.29 years, 129 males), 31 patients failed to respond while 35 had a recurrence after initial response; the overall success rate being 70.3% at a mean follow-up of 25 months. No difference was observed in demographics, clinical presentation, presence of hematuria, disease duration and mean urinary TGs loss between responders and non-responders. On multivariate analysis, patients with treatment failure were found to have a higher-grade disease (14.3% Grade-I, 36.6% Grades-II and 60% Grade-III), higher number of pretreatment courses (1.59 ± 1.08 vs. 1.02 ± 0.79) and heavier cholesterol (26.54 ± 23.46 vs. 8.81 ± 8.55 mg/dl) loss at baseline compared with responders (P < 0.05). Conclusion: Conservative management has a success rate in excess of 70%, not affected by the disease chronicity, previous episodes and recurrent nature. However, higher-grade disease, extensive pre-treatment with drugs and higher urinary cholesterol loss at baseline are the predictors of poor response. Hematuria is not an independent poor risk factor for conservative management

Ali Guermazi - One of the best experts on this subject based on the ideXlab platform.

  • lymphangiography in the diagnosis and localization of various chyle leaks
    CardioVascular and Interventional Radiology, 2012
    Co-Authors: Steven Deso, Nii-kabu Kabutey, Ali Guermazi, Benjamin Ludwig, Ducksoo Kim
    Abstract:

    Chyle leaks are rare entities infrequently encountered by most physicians. However, large centers providing advanced surgical care are inevitably confronted with chyle leaks as a complication of surgery, an extension of disease, or as a primary disorder. Regardless of the etiology, proper diagnosis and localization are paramount in the management of any chyle leak. Here we present 16 patients with 17 chyle leaks (5 Chyluria, 8 chylothorax, and 4 chylous ascites) who underwent bipedal lymphangiography (LAG) and postprocedure computed tomography (CT) imaging. In each case, the source of the chyle leak was identified and properly localized to guide further treatment. Of the 16 patients who underwent LAG and postprocedure CT imaging, the initial LAG alone provided the diagnosis and localized the chyle leak in 4 patients (25%); the postprocedure CT imaging provided the diagnosis and localized the chyle leak in 6 patients (37.5%); and the two modalities were equal in the diagnosing and localizing the chyle leak in the remaining 6 patients (37.5%) These cases highlight the unparalleled abilities of LAG and the added benefit of post-LAG CT imaging in the diagnosis and fine anatomic localization of chyle leaks. In addition, these cases demonstrate the retained utility of LAG in these investigations despite the development of alternative tests involving CT, magnetic resonance imaging, and nuclear medicine imaging.

  • lymphangiography in the diagnosis localization and treatment of a lymphaticopelvic fistula causing Chyluria a case report
    Vascular and Endovascular Surgery, 2010
    Co-Authors: Steven Deso, Rajendran Vilvendhan, Nii-kabu Kabutey, Ali Guermazi
    Abstract:

    We present a 25-year-old man with Chyluria resulting from a posttraumatic, postinflammatory lymphaticopelvic fistula. This aberrant connection between the lymphatic system and the urinary tract is rarely seen in the United States and can be difficult to diagnose. In this particular case, lymphangiography and postprocedure computed tomography (CT) imaging were used to diagnose and localize a fistula involving the right renal pedicle lymphatics and right urinary collecting system. This fistula ultimately resolved after the procedure and did not require sclerotherapy or surgical intervention. Lymphangiography is now rarely performed at most centers due to advancements in alternative diagnostic imaging modalities. However, this procedure remains a useful tool for the investigation and treatment of Chyluria and other chyle leaks.

Ilya G Glezerman - One of the best experts on this subject based on the ideXlab platform.

  • two cases of spontaneous remission of non parasitic Chyluria
    Clinical Biochemistry, 2017
    Co-Authors: Damodara Rao Mendu, Hillel Sternlicht, Lakshmi V Ramanathan, Melissa S Pessin, Martin Fleisher, Guido Dalbagni, Edgar A Jaimes, Anna Kaltsas, Ilya G Glezerman
    Abstract:

    Abstract Objectives Chyluria is a medical condition with presence of chyle in urine. The disease is most prevalent in South East Asian countries mostly caused by parasitic ( Wuchereria bancrofti ) infections. Our objective was to investigate the spontaneous remission of non-parasitic Chyluria. Design and methods The spontaneous remission of non-parasitic Chyluria cases were worked up with diagnostic investigations, clinical assessment and studied in detail with respect to their natural evolution. Results We present two patients who were evaluated in the nephrology clinic with symptoms of milky urine and painless hematuria. Midnight blood smear was negative for filarial parasites. Urine culture was without mycobacteria. Urine cytology and IgG western blot for cysticercus were negative. Imaging for a lymphatic leak by lymphoscintigraphy was unrevealing. Chyluria resolved spontaneously in both patients. Conclusions In our cases, radiologic visualization via lymphoscintigraphy was unrevealing. The patients were managed conservatively and fortunately underwent spontaneous remission marked by the disappearance of Chyluria within several months of her initial diagnosis. In our opinion this spontaneous remission could be due to unrevealed lymphatico-renal fistula collapse or sclerosis of lymphatics caused by contrast media.

Dingyi Liu - One of the best experts on this subject based on the ideXlab platform.

  • unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography
    BMC Urology, 2018
    Co-Authors: Dingyi Liu, Weimu Xia, Boke Liu, Qi Tang, Haidong Wang, Jian Wang, Yanfeng Zhou, Mingwei Wang, Wenlong Zhou, Yuan Shao
    Abstract:

    To identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic Chyluria undetectable by ordinary contrast CT. Eighteen patients 44–63 years of age with persistent idiopathic Chyluria who failed conservative management were included. Ordinary CT had not revealed a chyle leak. Cystoscopy, unilateral LPG, and post-LPG CT angiography (CTA) were sequentially performed. Ligation and stripping of the perirenal lymphatics were subsequently performed guided by lymphangiography and CTA. LPG and post-LPG CTA detected 17 unilateral and one bilateral chyle leaks in the 18 patients, with clear images of the communication of lymphatic vessels and the renal collecting or vascular system. The success rate was significantly better than cystoscopy (100% vs 50.0%, P = 0.005) or LPG alone (100% vs. 72.2%, P = 0.016). Chyluria resolved after surgery in all patients; no relapses were found. LPG plus post-LPG CTA accurately characterized perirenal lymphangiectasia that was not demonstrated by routine contrast-enhanced CT or not suitable for magnetic resonance imaging. Despite of its invasiveness, this method is a good diagnostic alternative to LPG in patients with persistent Chyluria requiring surgery.

  • Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography
    BMC, 2018
    Co-Authors: Dingyi Liu, Weimu Xia, Boke Liu, Qi Tang, Haidong Wang, Jian Wang, Yanfeng Zhou, Mingwei Wang
    Abstract:

    Abstract Background To identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic Chyluria undetectable by ordinary contrast CT. Methods Eighteen patients 44–63 years of age with persistent idiopathic Chyluria who failed conservative management were included. Ordinary CT had not revealed a chyle leak. Cystoscopy, unilateral LPG, and post-LPG CT angiography (CTA) were sequentially performed. Ligation and stripping of the perirenal lymphatics were subsequently performed guided by lymphangiography and CTA. Results LPG and post-LPG CTA detected 17 unilateral and one bilateral chyle leaks in the 18 patients, with clear images of the communication of lymphatic vessels and the renal collecting or vascular system. The success rate was significantly better than cystoscopy (100% vs 50.0%, P = 0.005) or LPG alone (100% vs. 72.2%, P = 0.016). Chyluria resolved after surgery in all patients; no relapses were found. Conclusions LPG plus post-LPG CTA accurately characterized perirenal lymphangiectasia that was not demonstrated by routine contrast-enhanced CT or not suitable for magnetic resonance imaging. Despite of its invasiveness, this method is a good diagnostic alternative to LPG in patients with persistent Chyluria requiring surgery

  • right crossed fused renal ectopia l shaped kidney type with urinary Chyluria
    Urologia Internationalis, 2015
    Co-Authors: Dingyi Liu, Haofei Wang, Weimu Xia, Zhoujun Shen
    Abstract:

    Crossed fused renal ectopia combined with Chyluria is extremely rare. Here we report the case of a patient who was admitted to our institution since milky urine and was finally found to have an L-shaped fused kidney and renal pelvis fistula. The patient was cured by renal pelvic instillation sclerotherapy.