Medical Science: Updates and Prospects Vol. 11

Chyluria is an uncommon but clinically significant disorder characterised by the passage of chyle into the urine secondary to abnormal lymphatic-urinary communication. Traditionally associated with lymphatic filariasis in endemic tropical regions, particularly South and Southeast Asia, the spectrum of chyluria has broadened considerably with increasing recognition of non-parasitic causes such as malignancy, trauma, tuberculosis, congenital lymphatic malformations, and iatrogenic lymphatic injury. Although many patients present with intermittent passage of milky urine, severe disease may result in haematochyluria, recurrent clot retention, malnutrition, immunosuppression, and debilitating metabolic derangements. Over recent decades, substantial advances have been made in understanding lymphatic pathophysiology, diagnostic imaging, endourological intervention, and minimally invasive surgical management. Conservative therapy remains the cornerstone for mild disease; however, renal pelvic instillation sclerotherapy has emerged as the principal minimally invasive therapeutic modality for persistent disease. In refractory cases, pyelolymphatic disconnection continues to represent the definitive surgical intervention, with laparoscopic and robotic approaches increasingly replacing traditional open surgery. Emerging strategies, including lymphatic embolisation and lymphaticovenous microsurgical reconstruction, are expanding therapeutic possibilities in selected patients.

This chapter provides a comprehensive review of the epidemiology, aetiopathogenesis, clinical presentation, diagnostic evaluation, and contemporary management of chyluria. Particular emphasis is placed on the comparative analysis of sclerosant agents, technical considerations during intervention, evolving minimally invasive surgical approaches, and long-term outcomes. Current evidence gaps, controversies, and future directions are also discussed.