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 undergone sclerosing therapy for chyluria with complete remission 40 years previously. The chyluria recurred 4 months before the present hospital admission. The patient presented with acute urine retention and weight loss of 6 kg during the past 6 months. Urine biochemistry studies showed elevated concentrations 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 chyluria. Intravenous urography showed a substantial filling defect in the urinary bladder. Cystoscopy revealed milky urine flowing out of the right ureteral orifice, and a large chylous coagulum presenting as a cyst-like mass in the urinary bladder. The chyluria was successfully treated with sclerosing therapy with injection of 76% Urografin (Shering AG, Berlin, Germany) into the right upper urinary tract, and the chylous coagulum was evacuated endoscopically. No evidence of chyluria recurrence has been noted during a year of follow-up, and the patient has regained 6 kg of body weight. This particular presentation of chylous coagulum in a chyluria patient has not been previously reported in the literature.