| ORIGINAL ARTICLE |
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| Year : 2014 | Volume
: 30
| Issue : 1 | Page : 23-27 |
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Factors affecting response to medical management in patients of filarial chyluria: A prospective study
Neeraj Kumar Goyal1, Apul Goel1, Satyanarayan Sankhwar1, Vishwajeet Singh1, Wahid Ali2, SM Natu2, Bhupendra Pal Singh1, Rahul Janak Sinha1, Divakar Dalela1
1 Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
Correspondence Address:
Apul Goel
Department of Urology, King George Medical University, Lucknow 226 003, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-1591.124201
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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. |
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