Surgical treatment of tuberculosis of the kidney with a total lesion of the ureter

The study was aimed to improve the efficiency of surgical treatment of renal tuberculosis with total lesion of the ureter. The clinical course and the results of surgical treatment of 104 patients with extended or multiple ureteral strictures of specific (n=92) and non-specific (n=12) etiology. Thirty-five patients with nephrotuberculosis underwent percutaneous needle-guided nephrostomy (PNGNS), 79 underwent surgery with removal of organs: open nephrectomy with lumbar access (48), combined nephroureterectomy (31). According to the evaluation the glomerular filtration rate after PNGNS, value less than 10 ml/min led to performing nephrectomy, more than 10 ml/min - ureteroplasty. It was established that combined nephroureterectomy has significant advantages in the case of specific kidney disease, despite a long duration as compared with a nephrectomy. Removal of the kidney with ureter in patient with nephrotuberculosis is the prevention of persistent dysuria, empyema of ureter stump, its possible malignant transformation, and contributes to significant improvement of quality of life of the patient. Of the 35 patients after CHPNS, 25 underwent intestinoplasty of ureter: ileum was used in 23 patients, appendix- in 2 patients. It is shown that reconstructive surgery using small intestine allows to release 92% of patients from a lifetime external drainage of the kidney.

tuberculosis of the kidney, nephroureterectomy, intestinoplasty