Role of Nephrectomy in the Treatment of Non-Functioning or Very Poorly Functioning Unilateral Tuberculous Kidney

Flechner, Stuart M.; Gow, J. G.

doi:10.1016/s0022-5347(17)56149-2

Cited by 53 publications

(47 citation statements)

References 17 publications

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“…The most common indications for nephrectomy include symptomatic hydronephrosis, shrunken kidney, infection, hypertension, polycystic kidney disease, and trauma or renal calculus [1, 2, 3, 4, 5, 6]. Nephrectomy for benign renal disease is a routine operation which is usually performed via a standard flank incision.…”

Section: Introductionmentioning

confidence: 99%

Nonrandomized Comparison of Open Flank versus Laparoscopic Nephrectomy in 249 Patients with Benign Renal Disease

Fornara

Doehn²,

Friedrich³

et al. 2001

Eur Urol

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Section: Introductionmentioning

confidence: 99%

Nonrandomized Comparison of Open Flank versus Laparoscopic Nephrectomy in 249 Patients with Benign Renal Disease

Fornara

Doehn²,

Friedrich³

et al. 2001

Eur Urol

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“…A kidney that is unsalvageable or is nonfunctional despite adequate drainage and medical treatment may require nephrectomy. 16 Surgery may be open or laparoscopic, as in this case. TB was once thought to be a contraindication to retroperitoneoscopic nephrectomy due concerns of a high conversion rate.…”

Section: Discussionmentioning

confidence: 99%

Genitourinary tuberculosis masquerading as a ureteral calculus

Wong

Hoag

Jones

et al. 2013

CUAJ

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The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis. Case reportWe report the case of an otherwise healthy 37-year-old male that was referred for extracorporeal shock wave lithotripsy (ESWL) of a presumed left ureteric stone. The patient reported a 2-month history of left flank pain and 5 months of intermittent hematuria. He also reported several months of feeling unwell with occasional fever. The patient was an immigrant from the Philippines, who works as a prison guard in Canada. Physical examination was unremarkable. A kidney, ureter, bladder (KUB) radiography pre-ESWL revealed a 5 × 4-mm oval calcified density within the left hemipelvis that was presumed to represent a ureteral calculus (Fig. 1). Based on history and imaging review, non-contrast and subsequently contrast-enhanced abdominal/pelvis computed tomography (CT) scan were obtained to further workup the etiology of the calcification. These studies demonstrated left hydroureteronephrosis, with renal parenchymal and calyceal calcifications, but no ureteric calculus (Fig. 2). There were innumerable septated cystic lesions throughout the left renal parenchyma that was suspicious for a chronic infection, such as genitourinary (GU) tuberculosis (TB).Urinalysis demonstrated hematuria with sterile pyuria. The patient underwent full evaluation for a working diagnosis of GU TB; chest X-ray was normal. Sputum acid-fast bacillus (AFB) tests were negative. Urine AFB and polymerase chain reaction (PCR) were positive for TB infection. The patient was subsequently medically treated with TB quadruple therapy: Isoniazid, rifampin, ethambutol and pyrazinamide. Urine culture demonstrated growth of Mycobacterium tuberculosis.Due to the presence of left-sided obstruction, cystoscopy was performed for attempted left ureteric stent insertion. Direct visualization revealed an erythematous and friable bladder mucosa with diffuse bleeding. The left ureteric orifice was unable to be visualized. A left percutaneous nephrostomy tube was placed. Antegrade nephrostogram demonstrated dilatation and distortion of the obstructed collecting system with pan-ureteral strictures (Fig. 3).Due to the extensive involvement of the kidney and ureter, reconstruction of the left-sided collecting system and ureter to alleviate the obstruction was not felt feasible upon consensus review. In the setting of a normal, functioning contralateral kidney on nuclear renogram, opinion favoured delayed laparoscopic nephrectomy. After several months of medical treatment and once the urine culture was negative for TB, the patien...

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“…However, it should be appreciated that late complications of in situ non-functioning tuberculous kidneys include: draining fl ank sinuses, abscess formation and hypertension. Indeed, the incidence of hypertension in patients with unilateral non-functioning or poorly functioning tuberculous kidneys has been reported to be approaching 25% with two-thirds of these patients benefi tting from a decrease in blood pressure after nephrectomy [ 5 ] .…”

Section: Managementmentioning

confidence: 99%