Cyst-like chylous coagulum in the urinary bladder of a patient with recurrent chyluria

We report a rare case of recurrent chyluria in a 64-year-old man, who had u ndergone sclerosing therapy for chyluria with complete remission 40 years p reviously. The chyluria recurred 4 months before the present hospital admis sion. The patient presented with acute urine retention and weight loss of 6 kg during the past 6 months. Urine biochemistry studies showed elevated co ncentrations of albumin (0.7 g/dL), globulin (0.6 g/dL), cholesterol (0.59 mmol/L), and triglyceride (0.89 mmol/L), confirming the diagnosis of chylur ia. Intravenous urography showed a substantial filling defect in the urinar y bladder. Cystoscopy revealed milky urine flowing out of the right uretera l orifice, and a large chylous coagulum presenting as a cyst-like mass in t he urinary bladder. The chyluria was successfully treated with sclerosing t herapy with injection of 76% Urografin (Shering AG, Berlin, Germany) into t he right upper urinary tract, and the chylous coagulum was evacuated endosc opically. No evidence of chyluria recurrence has been noted during a year o f follow-up, and the patient has regained 6 kg of body weight This particul ar presentation of chylous coagulum in a chyluria patient has not been prev iously reported in the literature.