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...

Descripción completa

Detalles Bibliográficos
Autores principales: Goyal, Neeraj Kumar, Goel, Apul, Sankhwar, Satyanarayan, Singh, Vishwajeet, Ali, Wahid, Natu, S. M., Singh, Bhupendra Pal, Sinha, Rahul Janak, Dalela, Divakar
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