Surgical management of renal tuberculosis

Krishnamoorthy, Sriram; Gopalakrishnan, Ganesh

doi:10.4103/0970-1591.42620

Cited by 31 publications

(10 citation statements)

References 30 publications

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“…The literature lacks strong evidence regarding the recommendation on partial nephrectomy in the case of a single, small TB lesion. Although some series on this topic are available, most of the authors agree that nephrectomy should be always be considered because of the risk of reactivation of misdiagnosed renal foci [ 69 ]. With regard to the best surgical approach, a consensus does still not exist.…”

Section: Resultsmentioning

confidence: 99%

Genitourinary Tuberculosis: A Comprehensive Review of a Neglected Manifestation in Low-Endemic Countries

et al. 2021

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Genitourinary tuberculosis (GUTB) represents a disease often underestimated by urological specialists, particularly in settings such as the European one, where the pathology is less frequent. Similar to other uncommon diseases at these latitudes, GUTB is a neglected clinical problem. In this light, the aim of this review is to give a comprehensive overview of GUTB in order to provide a useful tool for urologists who seldomly manage this disease. A non-systematic review of genitourinary tuberculosis was performed on relevant articles published from January 1990 to July 2021 using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. GUTB represents up to a quarter of extrapulmonary tuberculosis (EPTB) cases. Diagnostic, therapeutic and surgical work-up have been deeply reviewed and summarized. The mass migration of refugees to Europe as well as the ease of international travel is gradually leading to an upsurge in urological diseases such as GUTB, which were previously only rarely encountered in some European countries. The poor TB knowledge of European urologists should be improved through medical education courses, webinars or telematic means.

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Section: Resultsmentioning

confidence: 99%

Genitourinary Tuberculosis: A Comprehensive Review of a Neglected Manifestation in Low-Endemic Countries

et al. 2021

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“…However, it is not useful in most patients except in those with scrotal manifestations [ 17 ]. CT-urogram was a useful investigation to detect anatomical abnormalities that are characteristic of TB such as ureteric stricture, unusual parenchymal calcification, renal/peri-renal abscesses and non-functioning kidney [ 4 , 18 , 19 ]. Cystoscopy and bladder biopsy was very useful in clinching the diagnosis in those with haematuria and lower urinary tract symptoms [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, 6 months of ATT may not be adequate in patients with a high burden of diseased tissue [ 21 ]. Unlike in pulmonary TB, surgery in GUTB is an important adjunct [ 18 ]. Surgical procedures should be done after 4–6 weeks of anti TB therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

et al. 2021

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Background Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. Methods Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6–96). Results There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26–75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. Conclusions The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

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“…Tubercular involvement of prostate gland is known to present as granulomatous prostatitis [2] . Prostate tuberculosis is usually asymptomatic and as an incidental prostatectomy finding.…”

Section: Discussionmentioning

confidence: 99%