SURGICAL INTERVENTION IN THE MANAGEMENT OF PATIENTS WITH GENITOURINARY TUBERCULOSIS- A PROSPECTIVE STUDY

Abstract

Background: Genitourinary tuberculosis is a popular health disease prevalent in the Indian scenario. Early diagnosis is crucial to prevent its progression to renal failure . This study presents the experience of surgical intervention of genitourinary tuberculosis cases in a tertiary care hospital. Materials and Methods: Fifty patients of both genders undergoing elective surgical intervention for GUTB between Febraury 2022 and May 2023 were prospectively recruited in this study. The preoperative and postoperative investigations were done as per the institutional protocol. Results: In this study of 50 patients, more number of males (26) suffered from GUTB than females (24). Sixty percent of the patients were aged between 20 and 40 years. The mean age was 46.14 ± 10.16years. Imaging studies of the urinary system were abnormal in 80% of the patients with hydronephrosis being the most frequent presentation. Flank pain was the most common symptom experienced in 39 cases. The ureter was the most commonly involved organ (29 patients) for whom surgical intervention was performed, followed by kidney (12 patients) and bladder (9 patients). Psoas abscess compounding to the kidney involvement was seen in 2 cases . PUJ-associated obstruction was involved in 4 cases . One patient presented with tuberculosis in the left ovary with a colovesical fistula. Conclusion: Diagnosis of GUTB can be confounding, compelling a high index of suspicion owing to the paucibacillary load, in the biological specimens and the difficulty in isolating or culturing TB bacilli. Hence, a strong clinical suspicion is essential for the correct and early diagnosis and delay diagnosis of genitourinary tuberculosis may result in major organ damage necessitating either organ removal or reconstructive surgeries. The first line of medical treatment of multidrug chemotherapy should be supplemented with judicious surgery (as indicated) as the ideal management for restoration of the genitourinary tract function

Keywords

• genitourinary tuberculosis
• ureteric stricture
• thimble bladder
• boari flap
• ureteroneocystostomy