Abstract Purpose Chyluria is a rare fistulous communication between the lymphatic system and the urinary tract. We present the endoscopic management in severe chyluria employing sclerotherapy.Materials and methods We present an 18-year-old boy, referred with a history of passing milky urine for 12 months. Magnetic Resonance (MR)-Lymphangiography showed a lymphatic malformation involving the perineum, around the prostate, anal canal, and the seminal vesicles. Cystourethroscopy using 8/9.8F integrated scope showed a normal anterior urethra, white plaque-like lesions over the verumontanum, posterior urethra, and around both ureteric orifices. In addition, the bladder contained copious amounts of chylous fluid. An isolated chylous leak was noted from the right periureteric lesion in the first intervention. Persistent mild chyluria lead to a second look 3 months later confirming a leak from the left periureteric lesion. The lesions were injected (Deflux needle) with 1 ml (first treatment) and 0.5 ml (second treatment) of 3% sodium tetradecyl sulfate foam (STS:Air, 1:1). The ureteric orifices were observed for ureteric jets to confirm the easy passage of urine.Results The patient was discharged the same day and remains completely asymptomatic for the last 4 months.Conclusion Endoscopic sclerotherapy with STS was able to achieve complete clearance of chyluria. It is an effective approach and associated with minimal morbidity.
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