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Since 1970 short course regimes of chemotherapy have been adopted for the treatment of 87 patients suffering from genitourinary tuberculosis. The response to chemotherapy, the effect of surgery, the importance of hypertension and the relapse rate have been studied. It is concluded that all cases of genitourinary tuberculosis will respond to a short intensive course of chemotherapy, which need not be given for longer than 6 months.

The small contracted tuberculous bladder is often associated with vesico-uretenic reflux which, from the resultant ureteric and pelvic dilatation, is responsible in many cases for severe renal insufficiency which contraindicates entercystoplasty. In order to improve kidney function and consequently render plastic enlargement of the bladder feasible, it may be useful to induce complete incontinence of urine by means of wide TUR of the bladder neck extending to the external sphincter. By eliminating back pressure in the urinary tract, incontinence produces a regression of this dilatation and improved renal function. Following enterocystoplasty perfect continence is restored.

Results of a retrospective study of 72 patients with urogenital tuberculosis admitted to Hôpital Cochin Paris, from 1970 to 1980, were compared with those of studies conducted since 1945. Though there has been a marked reduction in the number of cases of tuberculosis in absolute terms, morbidity has not altered as a nephrectomy was performed in 44 p. cent of cases both in the period 1970 to 1980, and the year 1950. There has, however, been a noticeable increase in the use of plastic surgery. Future perspectives involve both the medical and surgical fields, in the former leading to a shorter period (9 months) of treatment, and in the latter by the development of new endoscopic procedures: modelling ureteral sounds, and hydrostatic bladder distention. It is reasonable to assume that surgery will be required less often in the future, medical treatment involving endoscopic procedures being sufficient to treat the majority of urogenital tuberculosis cases.

The clinical and radiological features of 16 children with urogenital tuberculosis are reviewed. The possibility of urinary tract involvement should be considered in all children with evidence of past or active pulmonary tuberculosis, or who are primary contacts.

Relapse occurred in 53 cases out of 838 consecutive cases of genito-urinary tuberculosis, followed for periods of 11 months to 27 years. Initial and recurrent disease is classified, and the treatment given is described. Length of inactivity is estimated, and correlated with the type of therapy given. Sensitivity of the organisms to chemotherapy is stated. Conclusions suggest that a life-long follow-up, at yearly intervals, of patients with genito-urinary tuberculosis is justified, as recurrences are diagnosed early, destructive changes are than unlikely, further surgery may be avoided, and a repeat course of chemotherapy is usually curative.

The problem in the treatment of genitourinary tuberculosis was to find a new regimen of chemotherapy that was shorter in time but equally effective as the traditional 2-year method, using streptomycin, isoniazid and para-aminoslicylate. A short course of treatment using rifampin, isoniazid and ethambutol was then devised, the method depending on the severity of the disease using the Semb classification. This short course of chemotherapy was combined with an early operation in advanced or extensive disease in the urinary tract. The regimen is as satisfactory as the traditional method and a followup of 2 years is all that is necessary.

The problem of genito-urinary tuberculosis particularly for developing countries is stressed. The clinical presentation is outlined and investigations discussed, special mention being made of the importance of the high dose intravenous pyelogram and the limited use of retrograde pyelogram, cystography and arteriography. The most important part of the article is the chemotherapeutic treatment; and the significance of the short course regimen which should now be the standard practice. The reasoning of this method of treatment is discussed and toxicity is briefly mentioned. Surgical treatment is presented within the context of modern short course chemotherapy and is discussed under two headings "Excision of diseased tissue" and "Reconstructive surgery".

In spite of the constant regression in newly notified Tbc patients, the percentage of extrapulmonary tuberculosis, especially of the urogenital region, remains unchanged at a high level. Modern therapy of urogenital tuberculosis is divisible into conservative, purely medicamentous treatment, possibly in combination with corticosteroids, and operative therapy, procedures preserving organs and rational eradication of tuberculous processes having to be carefully weighed against each other. The results of treatment are analyzed with reference to our own series of patients (n = 478).

Potent antituberculosis drugs and new endourological measures have changed the concept of management of urogenital tuberculosis. This paper presents a report on 56 patients treated with rifampicin, ethambutol and isoniazid for 1 year. Therapy was started in hospital and continued on an ambulatory basis. Reconstructive surgery was carried out as early as 4-5 weeks after commencement of therapy, whereby only destroyed organs wee removed. Follow up continued at three-monthly intervals for a period of 2-5 years after completion of chemotherapy. All patients were cured.

In patients with advanced carcinoma of the bladder not involving the trigone, radical total cystectomy with bladder replacement (replacement cystoplasty) using either the colon, ileum or stomach can be performed. In male patients, the prostatic urethra is always included in the resection so that the extent of radical surgery is not compromised. Thus the neobladder is anastomosed to the membranous urethra in these patients. In patients with contracted tuberculous bladder, the neobladder is anastomosed to the trigone after subtotal cystectomy (augmentation cystoplasty). The pattern of micturition is studied in 32 patients with cystoplasty after cystectomy. Emptying of the neobladder is achieved and completed mainly by abdominal straining rather than by the spontaneous contraction of the gastrointestinal segment, as evidenced by cystometric studies. The stomach generates high pressures during its peristaltic contractions but this could be a disadvantage during the early postoperative period particularly in the females, as urinary incontinence may result. In the majority of patients, micturition takes place every 2 to 3 hours with full urinary continence during the waking hours. However, in patients after radical total cystectomy, incontinence of urine during deep sleep is inevitable. No differences of voiding pattern, bladder capacity and residual urine volume are noted when either the colon, ileum or stomach is used for cystoplasty.

The authors deal with their experience on 34 cases of urogenital tuberculosis they treated between 1961 and 1972. The follow-up runs over at least 3 years.