In consequence of this violent interference with a large varix, of which that in the scrotum is but a part, chyluria, or elephantiasis of a leg, may supervene. The patient should be warned of this possibility.
Chyluria. Pathology.— When a lymphatic varix in the walls of the bladder, or elsewhere in the urinary tract, the consequence of filarial obstruction in the thoracic duct or in the lymphatics of the urinary system, ruptures, there is an escape of the contents of the lymphatics into the urine. Chyluria, or lymphuria, is the result.
Symptoms.— This disease frequently appears without warning; usually, however, pain in the back and aching sensations about the pelvis and groins probably caused by great distension of the pre-existing lymphatic varix— precede it. Retention of urine, from the presence of chylous or lymphous coagula, is sometimes the first indication of serious trouble. Whether preceded by aching, or by retention, or by other symptoms, the patient becomes suddenly aware that he is passing milky urine. Sometimes, instead of being white, the urine is pinkish or even red; sometimes, white in the morning, it is reddish in the evening, or vice versa. Sometimes, whilst chylous at one part of the day, it is perfectly limpid at another. Great variety in this respect exists in different cases, and even in the same case from time to time, depending on temporary closure of the rupture in the lymphatic, and also on the nature of the food.*[1]
Physical characters of chylous urine.— If chylous urine be passed into a urine glass and allowed to stand, as a rule, within a very short time, the whole of the urine becomes coagulated. Gradually the coagulum contracts until, at the end of some hours, a small, more or less globular clot, usually bright red or pinkish in colour, is floating about in a milky fluid.
- ↑ * The sanguineous appearance so frequently seen in chylous urine and in other forms of filarial lymphorrhagia probably depends in some instances on the formation of blood-corpuscles in lymph long retained in the varicose vessels, and as a result of the normal evolution of the formed elements in that fluid in other instances it is probably caused by rupture of small blood-vessels into the dilated lymphatics.
