Milky White Urine After Relief of Urinary Retention

Management of chyluria using percutaneous thoracic duct stenting

BACKGROUND

Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. CASE PRESENTATION : Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion.

CONCLUSION

This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.

Unusual case of recurrent urinary retention - A rare presentation of Chyluria

Chyluria presenting as milky white urine is a known presentation. But sudden and recurrent urinary retention without prior history of chyluria is very rare presentation. It also indicates the severity and tendency of passing tissue bits and clots through urine in rare cases. This case was diagnosed because of strong clinical suspicion. This case also highlights the management difficulty in these types of patients as patient had recurrent retention requiring bladder wash & had episodes of chylohematuria with chyle material and clots. This presentation is rare and adds to the list of differential diagnosis of acute retention.