Povidone used in the treatment of Chyluria

Indications of Povidone and Chyluria

Povidone is a solution that is used prior to surgery to sterilize the site of incision. Povidone itself is used to disperse or suspend a compound.

Povidone is completely soluble in cold and mild-warm water, ethyl alcohol, isopropyl alcohol, polyethylene glycol, and glycerol. Its stability in solution is much greater than that of tincture of iodine or Lugol's solution. Its CAS NO is 9003-39-8.

It was discovered at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski. They carried out tests in vitro to demonstrate anti-bacterial activity, and found that the complex was less toxic than tincture of iodine in mice. Human clinical trials showed the product to be superior to other iodine formulations. It was first sold in 1955, and has since become the universally preferred iodine antiseptic.

Chyluria is a recurrent problem in tropical countries; the disease is characterized by remission and exacerbation. The outpatient procedure commonly used is the endoscopic instillation of silver nitrate into the chylous effluxing ureter, where it acts as a sclerosant. Although the procedure enjoys wide popularity, it is not without attendant side-effects like pain and interstitial nephritis. To circumvent these problems, we used povidone iodine as a sclerosant.

Methods for the treatment of Chyluria

Povidone iodine is an iodine complex with the non-ionic surfactant polymer polyvinyl pyrrolidone; it is water-soluble and releases iodine slowly. Povidone iodine 0.2% (0.02% iodine w/v) for use as a sclerosant in treating chyluria is prepared as a 1:5 dilution of stock solution (2 mL of 5% povidone iodine plus 8 mL of distilled water) in distilled water.

Five patients have been treated to date; all underwent a routine physical examination and all tested positively for chyle in the urine. None of the patients had bacterial growth from urine samples in culture and all had normal renal functional values, albumin:globulin ratio and normal findings on IVU. Cystoscopy revealed chylous efflux from the left ureteric orifice in three patients and from the right in two. About 8–10 mL of povidone iodine was instilled using a ureteric catheter. All five patients were free of symptoms after 6 months of follow-up.

Advantages of Using Povidone iodine

Povidone iodine has the following advantages; it provides a nontoxic, non-irritating, nonvolatile and nonstaining form of iodine; it has local sclerosant action as well as antiseptic, antibacterial and antifungal actions; it is cheap and easily available; and it is easy to dilute to the required concentration. There were no complications after instillation, e.g. pain, fever, sepsis and interstitial nephritis.

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