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Urinary Tuberculosis with Renal Failure: Challenges in Management.

Vinayak Gorakhanath Wagaskar1, Rahul Arun Chirmade1, Vidyasagar Hansraj Baheti1

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Urinary tract reconstruction in patients with tuberculosis and renal failure presents challenges. Ileal conduit with nighttime drainage offers a stable option for severe cases, avoiding metabolic complications.

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Area of Science:

  • Urology
  • Nephrology
  • Infectious Diseases

Background:

  • India faces a high burden of tuberculosis (TB), with millions of cases annually.
  • Renal impairment is a common complication of urinary tract tuberculosis (UTTB), leading to renal mass destruction.
  • Reconstruction of the urinary tract in UTTB patients with renal failure poses significant surgical challenges.

Purpose of the Study:

  • To analyze the challenges associated with urinary tract reconstruction in patients suffering from urinary tuberculosis and concurrent renal failure.
  • To evaluate surgical outcomes for different reconstructive techniques in this patient cohort.

Main Methods:

  • A retrospective analysis of 31 patients with renal tuberculosis treated between August 2011 and August 2013.
  • Surgical interventions included uretero-calicostomy, augmentation cystoplasty with bilateral ureteric reimplantation, and ileal conduit formation.
  • Patient outcomes were assessed based on renal function (serum creatinine) and surgical success.

Main Results:

  • Eleven patients presented with serum creatinine above 2 mg/dl, indicating significant renal impairment.
  • Uretero-calicostomy resulted in restenosis and surgical failure in all cases.
  • Augmentation cystoplasty led to elevated creatinine, necessitating further procedures like percutaneous nephrostomy.
  • Ileal conduit procedures in patients with creatinine > 2.5 mg/dl remained stable with overnight drainage.

Conclusions:

  • Renal failure is not an absolute contraindication for urinary tract reconstruction.
  • Augmentation cystoplasty using large bowel segments can lead to metabolic complications and sepsis in renally impaired patients.
  • A short segment ileal conduit with continuous nocturnal drainage is a viable and safer option for severe renal impairment (creatinine > 2.5 mg/dl) to prevent metabolic complications.