Laparoscopic nephrectomy for nonfunctioning tuberculous kidney

Although laparoscopic nephrectomy for benign renal disease has been widely accepted, use of the operation for tubercular pyelonephritic kidney is relatively contraindicated because of difficulties in dissecting the dense fibrotic adhesions and the risk of spillage of caseous materials with subsequent dissemination of the disease. However, with the accumulation of experience, laparoscopic surgery is expanding its applications. In this study, we tried to evaluate the efficacy and safety of the laparoscopic nephrectomy for renal tuberculosis.

At three centers, 13 laparoscopic nephrectomies were performed between April 1996 and March 1999. The patients consisted of eight men and five women with a mean age of 44.8 years (range 37-51 years). All patients had known renal tuberculosis with a nonfunctioning kidney and underwent nephrectomy after at least 3 months of chemotherapy with four antituberculous drugs. Nine patients underwent the transperitoneal approach and four patients, the retroperitoneal approach. The follow-up was from 2 to 35 months with a mean of 15.8 months.

Kidneys were removed laparoscopically in 12 patients (92%). The mean operative time was 268 minutes (range 190-500 minutes), and the mean estimated blood loss was 227 mL. Although there had been some difficulties releasing the adhesions, no significant intraoperative and postoperative complications were observed. Conversion to open surgery was needed in only one patient. The mean hospital stay was 4 days, and the patients returned to normal activity within 10 days. Neither local recurrence nor distant dissemination of the disease was observed during the follow-up period.

Laparoscopic nephrectomy for renal tuberculosis was safe and effective with minor complications. Therefore, tuberculosis should not be a contraindication to a laparoscopic approach.