Outcomes of reconstructive surgery of tuberculosis affecting the ureter and bladder

Abstract

Background: Genito-urinary tuberculosis (GUTB) affects kidneys and bladder more frequently leading to scarring and eventually loss of function. Reconstructive surgical procedures are implemented to preserve the function by relieving obstruction of the urinary tract. The main objective of this study was to evaluate the outcome of urinary reconstructive surgical procedures in terms of improvement in renal function and quality of life.

Methods: This was retrospective analysis of all patients treated for tuberculous stricture of the ureter and scarring of the bladder from January 2001 to December 2005. Outcome of interventions were assessed using IVU, TC-DTPA renogram and serum creatinine level.

Results: Among the 160 genito-urinary tuberculosis cases diagnosed in the 5 year period, only 51 patients fulfilled the inclusion criteria and were managed with reconstructive surgery alone or in combination with temporary diversion. Sixteen (31.5%) patients had elevated serum creatinine level greater than 1.5mg% out of which Nadir serum creatinine level less than 1.5mg% was found in only 9 patients following various procedures. Pan urethral or multiple segment involvement occurred in 24 ureters of which 10 required eventual definitive reconstructive surgery. Twenty eight bladders were found scarred of which 17 needed augmentation procedures.

Conclusions: Based on acceptable renal function using Tc-scan, renogram and other functional assessments an overall favourable outcome of 92% at median follow up of 18 (6-48) months was observed.