病例報告: 使用50%葡萄糖灌注療法治療乳糜尿
劉昱良1、黃純真2、羅浩倫1
1高雄長庚醫院 外科部 泌尿科; 2高雄長庚醫院 解剖病理科
The Effect of Dextrose Instillation on a Man with Chylous
Hematuria: A Case Report
Yu-liang Liu1, Shun Chen Huang2, Hao Lun Luo1
Department of Urology1, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Anatomic Pathology2, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Introduction: Chyluria is described as the passage of milky white chylous urine due to the leakage of chylous material into the pelvicalyceal system. Renal pelvic instillation sclerotherapy which causes sclerosis of the fistulous connection is a minimally invasive treatment for chyluria resistant to conservative treatment. The benefit of sclerosing agents have been analyzed in previous studies; however, our patient has iodine allergy and silver nitrate is not available at our institution. So we chose 50% dextrose as sclerosing agents.
Case report: A 51‑year‑old male without relevant comorbidities came to our clinic because of milky urine in the recent 2 weeks. The urine was getting thicker associated with blood clot passage. He denied traveling history or trauma history in the recent 1 year. Urine analysis showed obvious proteinuria and hematuria, and retrograde pyelography found left renal pyelolymphatic backflow. The collected urine was
stained by Sudan III to confirm triglyceride content.
Results: We performed 50% dextrose 20 cc instillation twice daily for 3 days and repeated retrograde pyelography. The left pyelolymphatic backflow was much regressed, and urine was gradually getting clear.
Conclusions: Sclerotherapy using 50% dextrose is an alternative technique for the treatment of pyelolymphatic fistula. This case illustrates a role for this sclerosing agent in treating chyluria. The dextrose is safe, cheap, and easy to obtain. However, further randomized controlled studies are needed to evaluate the long‑term effectiveness of this sclerosing agent.