Is povidone iodine an alternative to silver nitrate for renal pelvic instillation sclerotherapy in chyluria?
OBJECTIVE
To compare the efficacy and toxicity of 1% silver nitrate, 0.2% povidone iodine and 50% dextrose in renal pelvic instillation sclerotherapy (RPIS) for chyluria.


METHODS
In a prospective randomized comparative study from January 1999 to June 2003, 106 patients (61 males and 45 females; mean age 36 years, sd 12, range 14-65) were randomized to receive 1% silver nitrate, 0.2% povidone iodine or 50% dextrose as RPIS. In all, nine doses were given at 8-h intervals, and patients followed at 6 weeks and then at 3-monthly intervals. Patients with 'persistence' or 'recurrence' of chyluria were treated with second course of RPIS using same sclerosant.


RESULTS
The dextrose treatment was discontinued at mid-term because of poor success (one of 21 patients, P < 0.001). Of 85 patients, 44 received silver nitrate and 41 povidone iodine; both groups were well-matched and the mean follow-up was 28.4 and 23.3 months, respectively. 'Immediate clearance' was recorded in 91% and 98%, and recurrence in 21% and 22% of patients after the first course of RPIS, after silver nitrate and povidone, respectively; Kaplan-Meier estimates of 'disease-free duration' in the two groups (23.6 vs 20.1 months) were also similar (P = 0.7906). The cumulative success rate after two courses of RPIS was 82% (silver nitrate) and 83% (povidone; P = 1.0). Five (11%) patients in the silver nitrate and one (2%) in the povidone group had significant flank pain during treatment.


CONCLUSIONS
Povidone iodine 0.2% is as effective for RPIS as 1% silver nitrate.
Goel
Shailendra
S
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
Mandhani
Anil
A
Srivastava
Aneesh
A
Kapoor
Rakesh
R
Gogoi
Sanjay
S
Kumar
Anant
A
Bhandari
Mahendra
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002913:Chyle; D018572:Disease-Free Survival; D005260:Female; D005368:Filariasis / Q000188:drug therapy; D006801:Humans; D007267:Injections; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*; D012835:Silver Nitrate / Q000008:administration & dosage* / Q000009:adverse effects; D014556:Urine; D014958:Wuchereria bancrofti
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D012835:Silver Nitrate