Ureteral involvement in genitourinary tuberculosis Review of 20 cases encountered over three years

Imaging of Tuberculosis

“…6) had a balloon dilatation performed with an ini tially satisfactory result, but later a nephrectomy had to be performed. Since no systemic follow-up was undertaken in our cases, we were unable to evaluate the possible risk for later development of ureteric strictures during medication that has been suggested previously (12).…”

Role of Early Endourologic Management of Tuberculous Ureteral Strictures

“…Traditional surgical management of tuberculous ureteral strictures includes cystoscopic ureteral dilation, ureterovesical reimplantation, cutaneous or intubated ureterotomy, open nephrostomy, or nephrectomy. 8,9 If surgical therapy should become necessary, it is wise to precede the operation with at least 3 weeks, and preferably 3 months, of chemotherapy. However, it has been suggested that tissue destruction may be accelerated greatly by obstructive strictures that can develop soon after initiation of medical therapy.…”

Reversible Uremia due to Bilateral Ureteral Obstruction from Tuberculosis

“…The left kidney showed only slight blunting of the calyces secondary to hydronephrosis, but miliary parenchymal lesions must have been present in order to cause the ureteral obstruction. Feldstein et al [19] re ported that in 12 of their 20 patients with ureteral involvement, new or progressive stricture formation oc curred following the diagnosis of pulmonary tuberculo sis while on chemotherapeutic drugs. The ureteral stric tures in our patient may have progressed after he was started on chemotherapy, as his renal function rapidly deteriorated thereafter.…”

“…Because genitourinary TB can be silent in a large number of patients, the finding of pulmonary or extrapulmonary TB should prompt in travenous pyelography in conjuction with urinalysis and culture for the bacillus. Pyelography should be repeated 1 month after the initiation of chemotherapy [19,23]. Any sign of genitourinary involvement should then mandate that intravenous or retrograde pyelography be performed monthly until regression or stabilization occurs, then quarterly for at least a year, and then with decreasing fre quency thereafter.…”

“…Patients with ureteral involvement on che motherapy may develop obstruction due to fibrosis and this may be relieved by steroids [23]. A combination of prednisone 20 mg daily for 3 months with chemotherapy has been reported to be beneficial [19].…”