Cargando…
Factors affecting response to medical management in patients of filarial chyluria: A prospective study
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. MATERIA...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897048/ https://www.ncbi.nlm.nih.gov/pubmed/24497677 http://dx.doi.org/10.4103/0970-1591.124201 |
_version_ | 1782300179177668608 |
---|---|
author | Goyal, Neeraj Kumar Goel, Apul Sankhwar, Satyanarayan Singh, Vishwajeet Ali, Wahid Natu, S. M. Singh, Bhupendra Pal Sinha, Rahul Janak Dalela, Divakar |
author_facet | Goyal, Neeraj Kumar Goel, Apul Sankhwar, Satyanarayan Singh, Vishwajeet Ali, Wahid Natu, S. M. Singh, Bhupendra Pal Sinha, Rahul Janak Dalela, Divakar |
author_sort | Goyal, Neeraj Kumar |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3897048 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-38970482014-02-04 Factors affecting response to medical management in patients of filarial chyluria: A prospective study Goyal, Neeraj Kumar Goel, Apul Sankhwar, Satyanarayan Singh, Vishwajeet Ali, Wahid Natu, S. M. Singh, Bhupendra Pal Sinha, Rahul Janak Dalela, Divakar Indian J Urol Original Article 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. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC3897048/ /pubmed/24497677 http://dx.doi.org/10.4103/0970-1591.124201 Text en Copyright: © Indian Journal of Urology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Goyal, Neeraj Kumar Goel, Apul Sankhwar, Satyanarayan Singh, Vishwajeet Ali, Wahid Natu, S. M. Singh, Bhupendra Pal Sinha, Rahul Janak Dalela, Divakar Factors affecting response to medical management in patients of filarial chyluria: A prospective study |
title | Factors affecting response to medical management in patients of filarial chyluria: A prospective study |
title_full | Factors affecting response to medical management in patients of filarial chyluria: A prospective study |
title_fullStr | Factors affecting response to medical management in patients of filarial chyluria: A prospective study |
title_full_unstemmed | Factors affecting response to medical management in patients of filarial chyluria: A prospective study |
title_short | Factors affecting response to medical management in patients of filarial chyluria: A prospective study |
title_sort | factors affecting response to medical management in patients of filarial chyluria: a prospective study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897048/ https://www.ncbi.nlm.nih.gov/pubmed/24497677 http://dx.doi.org/10.4103/0970-1591.124201 |
work_keys_str_mv | AT goyalneerajkumar factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT goelapul factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT sankhwarsatyanarayan factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT singhvishwajeet factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT aliwahid factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT natusm factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT singhbhupendrapal factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT sinharahuljanak factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy AT daleladivakar factorsaffectingresponsetomedicalmanagementinpatientsoffilarialchyluriaaprospectivestudy |