Is neoadjuvant chemotherapy necessary for the surgical treatment of renal tuberculosis?

Abstract

The relevance of urogenital tuberculosis remains high as well as its social significance. With the advent of anti-tuberculosis drugs it became possible to perform organ-preserving surgeries, both anti-tuberculosis chemotherapy in the preoperative period and after surgery is extremely important. Violation of this principle leads to the development of severe complications, which is demonstrated by clinical observation. Patient I., female 40 years. Diagnosis: polycavernous tuberculosis of the right kidney, cavernous tuberculosis of the left kidney, bladder tuberculosis of stage 4 (microcystis). Her anti-tuberculosis therapy was irregular and occasionally. In the general urology department a laparoscopic nephrectomy on the right and nephrostomy on the left were performed. Anti-tuberculosis therapy was discontinued, which led to the progression of renal failure and repeated attacks of pyelonephritis. In this regards she was re-operated in the Avicenna Medical Center: laparoscopic cavernotomy of the left solitary kidney and cystectomy with enterocystoplasty by Studer were performed. In the postoperative period a reservoir-uterine fistula was formed. She did not receive anti-tuberculosis therapy. The patient returned to the Avicenna Medical Center after 9 months, laparoscopic removal of the shrunken intestinal reservoir was performed with the formation of Bricker ileal conduit with a good short-term and long-term (follow-up period of 10 months) result.