Despite the efficacy of new chemotherapy regimens, the medical treatment of genitourinary tubercolosis leads to recovery without sequelae in only 17–47% of cases. Open or endoscopic surgery therefore maintains an important role in treatment of the disease. Eighty years ago nephrectomy was the treatment of choice of renal tubercolosis. Nowadays some authors limit nephrectomy to patients with intractable pain, uncontrollable secondary infections, life-threatening hematuria, uncontrollable hypertension or resistance of the mycobacterium to medical therapy. We believe nephrectomy should be performed in cases of extensive renal damage, with or without complete functional loss, and in any case should be associated with exeresis of the whole ureter. In the presence of localised lesions, such as infundibular scarring with closed-off calyx, we generally perform a calycectomy in order to avoid a relapse of the disease and other possible complications. Also in these cases, however, surgery is controversial. Another aspect under debate concerns the association between chemotherapy and steroids. These stenoses, often involving the ureter, can be treated endoscopically (placement of ureteral stent, balloon dilatation, ureterotomy) or surgically (pyeloplasty, ureteral reimplantation, ileal ureter replacement, renal auto-transplantation). A serious consequence of urogenital tuberculosis is the loss of bladder capacity. This condition may be effectively treated with cytoplasty using an intestinal segment. In conclusion, conservative or radical surgery is still necessary to treat many cases of urogenital tubercolosis.
AB074. Indications, techniques and outcomes for ileal ureter replacement: a multicenter experience in China
