Surgery for UGTB

Abstract

UGTB is an often contracted, but mostly overlooked, disease. The main reasons for late diagnosis are lack of alertness on UGTB in urologists and general practitioners relative to patients with UTI, kidney anomalies, renal cysts etc.; non-specific variable clinical features, decreasing positive cultures of MBT due to non-optimal empiric therapy for UTI with prescribing of fluoroquinolones and amicacin.

Standard chemotherapy is effective only for early diagnosed forms of UGTB, in complicated form modified schemes with five anti-TB drugs in combination with pathogenetic therapy is indicated. Destructive forms of kidney and male genital TB cannot be cured by chemotherapy, surgery is necessary. Although chemotherapy is the mainstay of treatment, ablative surgery as a first-line management may be unavoidable for sepsis or abscesses. In cases with hydronephrosis and progressive renal insufficiency caused by obstruction, renal drainage (by stenting or nephrostomy) must be performed immediately.

Bladder TB stage 4 (microcystis) is indicated for cystectomy following by enteroplastic. Radical cystectomy with full removing fibrotic tissue is preferable, and after augmentation relapse and complication is more probable. Bladder and ureter reconstruction with ileum is a good option in difficult cases of lack or irreversible damage of the urinary way.