Chyluria - a clinical and diagnostic stepladder algorithm with review of literature

Objectives: Chyluria is an infrequently discussed urological problem and a rare urological manifestation of filariasis. Apart from few isolated case reports the lit­erature regarding the etiology, diagnostic approach and management of chyluria is grossly inadequate. We un­dertook the present study to review chyluria in its entirety so as to have a broader insight in to its etiopathogenesis and to suggest the clinician with a proposed stepladder protocol approach (algorithm) towards its management. Methods: We made a detailed systematic data search for the period covering the last 37 years on the Pubmed for published English literature using the key words 'chy­luria', `milky urine' and 'hematochyluria'. The signifi­cant findings and recent advances on chyluria were reviewed. Results: About 250 articles were found; these were analyzed, tabulated and reviewed for their clinical ap­proach and management of chyluria. Conclusions: Though generally a harmless condition in a majority, chyluria should not be ignored, instead all cases must be aggressively investigated to arrive at a cause. These should then be managed on the lines similar to as proposed in our 10-stepladder protocol.