Unexpected tuberculosis causing ureteral stricture

Abstract

A 72-year-old-female was referred to our urology clinic with a 3-month history of dysuria, intermittent right flank pain, measured fevers and the computerized tomography finding of a dilated right renal collecting system with abnormal wall thickening (Fig. 1). Prior to her referral, she had undergone an outpatient gastroscopy and colonoscopy to investigate these symptoms, which found no abnormality and she had completed a course of trimethoprim prescribed by a primary care physician. Her medical history included osteoarthritis and hypertension and her physical examination was unremarkable. She was prescribed an appropriate antibiotic for a resistant Enterococcus isolated from a recent urine culture and was booked for cystoscopy, retrograde pyelography and flexible pyeloscopy.A cystoscopy was performed 3 weeks after clinic review and demonstrated several small erythematous patches on the bladder wall. Retrograde pyelography revealed multiple filling defects in the right renal collecting system from the mid-ureter to the renal pelvis ( Fig. 2) with no abnormalities on the left. Ureteroscopy of the right ureter was grossly abnormal, with cream-colored pseudomembranous change from the mid-ureter to the renal pelvis and areas of near total occlusion. Multiple biopsies of the abnormal ureteric material and erythematous bladder patches were collected, and a 4.8F multi-length ureteric stent was placed.A high fever (39.8°C) was recorded late on post-operative day 1. Cultures were performed, a chest radiograph was unremarkable and a full blood count revealed neutropenia (0.8 × 10 9 /L, reference range 2-7.5 × 10 9 /L). Further history revealed that she had experienced drenching night sweats and fevers periodically for several months, and had a complicated recent travel history including Morocco, China, Cambodia, Thailand, Laos, Chile and Mexico. She had migrated to Australia 50 years previously from a rural area in Chile.

Bladder tuberculosis with ureteral strictures after bacillus Calmette‑Guérin therapy for urinary bladder cancer: A case report

“…He initially needed bilateral ureteral stenting for stricture, but the stents were successfully removed after TB treatment. In some patients, ureteral stricture and contracted bladder caused by TB are irreversible and require surgical repair ( 10 , 13 , 14 ). Therefore, early detection of bladder TB and proper intervention is essential.…”

A guidewire introducer as a ureteral foreign body: A case report

“…Although rarely encountered, infectious pathologies, iatrogenic causes, ureteral stones, and their subsequent treatment via ureteroscopy and ureteral access sheaths are blamed for ureteral injury and subsequent ureteral strictures. [8][9][10][11][12][13][14] In this Fig. 1.…”