Analysis of milky white urine and varicocele: Professional protection of men's health

Milky Urine vs. Chyluria

Many men find that their urine sometimes appears milky white or like rice water. Some men become very worried and experience significant psychological stress after experiencing milky urine. What causes this? Is it a serious pathological condition? The phenomenon of milky urine requires specific analysis; it is not always a pathological condition. From a clinical perspective, milky urine is mainly related to the following factors: chyluria, phosphate urine, and pyuria.

(I) Chyluria

Chyluria is the mixing of chyle with urine. Chyluria accompanied by red blood cells is called chylous hematuria.

Under normal circumstances, chyle particles absorbed by the intestines are transported through the lymphatic vessels of the posterior abdominal wall into the vena cava and distributed throughout the body, providing the nutrients needed for metabolism in various tissue cells. Under certain pathological conditions (such as filariasis, tumors, etc.), normal lymphatic vessels become obstructed, leading to lymphatic dilation and increased intraluminal pressure. When the obstruction is severe and the pressure reaches a certain level, the lymphatic vessel wall ruptures, and a large amount of chyle leaks out. Rupture of lymphatic vessels in different locations can cause different clinical symptoms and manifestations. For example, rupture of abdominal lymphatic vessels results in a large amount of chyle flowing into the abdominal cavity, forming chylous ascites; rupture of lymphatic vessels near the urinary system, with the ruptured lymphatic vessel opening into the renal pelvis, ureter, or bladder, results in chyluria; rupture of small blood vessels accompanying lymphatic vessel rupture leads to chylous hematuria. It is generally believed that over 90% of lymphatic vessel obstructions are caused by filariasis, with a minority caused by tumor compression or inflammatory adhesions.

In the early stages of chyluria, there are generally no systemic symptoms; patients only occasionally notice their urine is milky, occurring intermittently. This is especially noticeable after exertion or eating high-fat foods, and chylous hematuria may sometimes occur. Excessive chyle can form clots that obstruct the ureter, causing difficulty urinating and renal colic. Long-term chyluria, due to excessive loss of fat and protein, can lead to weight loss, malnutrition, and fatigue.

While chyluria is relatively easy to diagnose, determining the underlying cause requires a comprehensive examination at a well-equipped hospital. Qualitative chyluria testing remains a crucial diagnostic method. The procedure is simple: collect the milky urine sample in a test tube, add reagents, and a positive result indicates chyluria; a negative result indicates not chyluria. If the cause remains unclear, microscopic examination of the urine supernatant can reveal numerous fat droplets, confirming the diagnosis.

Treatment for chyluria should begin after identifying the cause. If it is caused by filariasis, treatment for filariasis should be initiated first. If tumor compression is suspected, surgical intervention is recommended.

(II) Phosphate Urine

Phosphate urine or urate urine can also present as milky white urine, which can appear at the beginning or end of urination. It usually occurs at the end of urination, and there are no other discomforts besides the milky white color of the urine. The occurrence of urate and phosphate urine is not significantly related to a high-fat, high-protein diet or fatigue. This type of milky white urine is easily distinguished from chyluria. The cloudy urine will become clear after heating or adding acid to a test tube. The chyle qualitative test will be negative. This type of milky white urine generally does not require specific treatment; drinking plenty of water or taking alkaline medications during the occurrence of milky white urine will usually resolve the symptoms.

(III) Pyuria

Pyuria can also present as milky white urine, but it is accompanied by urinary tract irritation symptoms and clinical manifestations of urinary tract infection. A large number of white blood cells can be seen in the urinalysis, and the chyle qualitative test will be negative.

In summary, milky white urine requires specific analysis and treatment. Ideally, upon noticing milky white urine, collect the urine in a container and immediately take it to the hospital for examination to determine the cause. The doctor will then provide appropriate treatment.

Varicocele

The spermatic cord is composed of the vas deferens, cremaster muscle, testicular artery, pampiniform plexus, nerves, and lymphatic vessels. It originates from the upper end of the testis, passes through the inguinal canal, and enters the abdominal cavity. Varicocele is caused by various factors that obstruct the return of venous blood from the spermatic cord, leading to reflux and stagnation, resulting in the tortuous dilation of the pampiniform plexus.

(I) Causes of Varicocele

1. Anatomical Causes

① The veins of the testis and epididymis form a pampiniform plexus within the spermatic cord, ascending to the inguinal canal and entering the retroperitoneum. In the retroperitoneal space, it ascends at an oblique angle on the right side into the inferior vena cava, and at a right angle on the left side into the left renal vein. 1.

2.Varicocele Causes:

① The left spermatic vein has a longer course and forms a right angle at its entry into the renal vein, resulting in higher hydrostatic pressure and obstructed venous return, thus easily causing tortuous dilation of the pampiniform plexus.

② Compression of the left spermatic vein by the sigmoid colon and internal iliac artery obstructs venous return, leading to varicose veins.

③ Weak vein walls or incomplete development of the cremaster muscle.

3. Pathological Causes:

① Tumors compressing the spermatic vein obstruct venous return, especially in right-sided varicocele; the possibility of a tumor should be ruled out.

② Hydronephrosis compressing the renal vein obstructs venous blood return from the spermatic cord.

③ Ectopic vessels compressing the spermatic vein.

4. Other Causes:Prolonged upright posture affects venous blood return from the spermatic cord, also contributing to varicocele. Frequent increases in abdominal pressure also easily lead to this condition.

(II) Clinical Manifestations

Patients experience a feeling of heaviness or pressure in the scrotum when standing, which may radiate to the affected side of the groin and lower abdomen. This sensation worsens with walking or exertion and is relieved by lying down and resting. Some patients experience no discomfort. Physical examination reveals tortuous clusters of veins within the scrotum.

(III) Effects of Varicocele on the Human Body

Besides causing perineal discomfort, varicocele is also a significant factor affecting male fertility. However, not every patient with varicocele is infertile; many patients with varicocele have normal fertility.

The impact of varicose veins on male fertility is mainly twofold: First, due to the reflux of a large amount of renal venous blood into the spermatic veins, many metabolic waste products and harmful substances enter the testes and epididymis, toxically affecting the spermatogenic cells, hindering spermatogenesis, and causing spermatogenesis disorders or abnormal sperm development. Secondly, the large amount of venous blood stagnation in the scrotum causes a rise in local temperature, which is extremely detrimental to the development of spermatogenic cells, affecting their development and causing sperm abnormalities.

(IV) Treatment

Clinical treatment for varicocele primarily involves high ligation of the varicocele and puncture embolization; oral medications are ineffective. Whether surgery or embolization is necessary depends on the individual case; not every patient requires surgery. Surgical treatment should be considered for infertile men, patients with low sperm count and motility, severe varicocele, and those experiencing perineal pain or discomfort affecting daily life. Surgical treatment may not be considered for men who have already fathered children or those with mild varicocele without significant symptoms of heaviness or pressure.