Factors affecting response to medical management in patients of filarial chyluria: A prospective study.
BACKGROUND
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.


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).


CONCLUSIONS
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.
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Neeraj Kumar
NK
Goyal
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Apul
A
Goel
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Satyanarayan
S
Sankhwar
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Vishwajeet
V
Singh
Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India.
Wahid
W
Ali
Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India.
S M
SM
Natu
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Bhupendra Pal
BP
Singh
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Rahul Janak
RJ
Sinha
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Divakar
D
Dalela
Cholesterol; chyluria; filariasis; triglycerides