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Objective: To evaluate the long-term effectiveness and consequences of augmentation cystoplasty in adult patients with small capacity bladder due to genitourinary tuberculosis (GUTB)., Methods: After approval of the institutional ethical committee, we retrospectively analyzed the database of adult patients with small capacity bladder due to GUTB treated by augmentation cystoplasty from January 2010 to December 2022 at our center. The patients were followed up at 6 weeks postoperatively, then every 3 months for first year and 6 months in second year, and then annually. Patients were assessed for symptoms, renal function, blood biochemistry levels, and ultrasound KUB at each follow-up visit., Results: A total of 40 patients underwent augmentation cystoplasty were included. All patients underwent augmentation cystoplasty either with ileum (n = 35) or sigmoid colon (n = 5). On long-term follow-up, there was statistically significant improvement in bladder capacity, decrease in voiding frequency (P = .00), decrease in eGFR (P = .02) and increase in serum creatinine (P = .02). Significant complications were wound infection 4 (10%), intestinal obstruction 1(2.5%), urinary tract infection 6 (15%), bladder stone 2 (5%), mucus retention 3 (7.5%), hypocalcemia with metabolic acidosis 2 (5%) and need of intermittent catheterization in 11 (27.5%) patients., Conclusion: Multidrug therapy with judicious reconstructive surgery is the optimal treatment modality for GUTB with cicatrization sequelae. In GUTB, augmentation cystoplasty is a safe procedure and strict long-term follow-up is needed to prevent complications., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Although tuberculosis (TB) ranks among the most frequent infectious diseases worldwide, one of its extrapulmonary (EP) manifestations, genitourinary (GU) TB, is often underestimated by urologists, particularly in areas such as Europe where TB is not endemic. The aim of this review is to give urologists a concise overview of GUTB as a supplement to the more comprehensive European Association of Urology 2023 update on urological infections guidelines. EPTB can develop in 16% of TB cases. GUTB accounts for 4.6% of EPTB and is often asymptomatic or nonspecific, so it can be confused with other urogenital diseases. GUTB can be highly destructive, leading to failure of urogenital organs. Diagnosis is via microbiological, molecular, and histological testing for urine, genital secretions, or genitourinary tissue, supported by imaging. A 6-mo combinational medical regimen is the first-line treatment for GUTB. However, surgical interventions are also frequently required for the treatment of GUTB complications. Therefore, it is important to keep GUTB in mind for differential diagnosis. PATIENT SUMMARY: We reviewed scientific studies on the occurrence, diagnosis, and treatment of tuberculosis in the genitourinary tract. Our aim is to raise awareness among urologists from countries where this disease does not occur frequently, as urogenital tuberculosis can occur without any symptoms or with unspecific symptoms that can be confused with other diseases., (Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Despite the modest positive trends in the epidemic situation for tuberculosis, the incidence of extrapulmonary tuberculosis is not consistent. The relevance of urogenital tuberculosis remains high, as well as its social significance. Tuberculosis of the kidneys and urinary tract is often diagnosed late, when drug therapy is not enough and surgical treatment is required. A total of 78 national and foreign publications dedicated to surgical treatment of patients with urogenital tuberculosis were analyzed. Various surgical techniques for renal and bladder tuberculosis are described with a comparison of their advantages and disadvantages. Tuberculosis of the urinary system, like any infectious disease, can and must be cured with drug therapy. Unfortunately, there are complicating subjective (low alertness of doctors regarding tuberculosis, low adherence to national and international guidelines) and objective (absence of pathognomonic symptoms of urogenital tuberculosis, which results in late diagnosis, increased drug resistance of the pathogen, high comorbidity) factors. The advancements in surgical techniques and modern drugs for neoadjuvant therapy give patients the opportunity to receive minimally invasive treatment that saves not only life, but also provides them acceptable quality of life.

Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

<b>Background:</b> Genitourinary tuberculosis is one of the most common forms of extra-pulmonary tuberculosis. Owing to a myriad of clinical presentations and discrepancies in the diagnostic modalities, patients usually present late, which results in a high number of them requiring surgical intervention. The present study aims to retrospectively analyze the role of surgery in genitourinary tuberculosis. <br><b>Patients and method:</b> All patients diagnosed with genitourinary tuberculosis at our centre between October 2017 and September 2019 were included in the study. The mode of presentation, duration of symptoms, investigations performed, treatment received, and follow-up were studied. <br><b>Results:</b> Out of 25 patients diagnosed with genitourinary tuberculosis (GUTB), there were 15 (60%) males and 10 (40%) females. The mean age of presentation was 40.84 years. Nineteen (76%) patients underwent surgical intervention, and many patients required more than one surgical procedure. A reconstructive procedure was carried out in seven patients. At a median follow-up of 12 months, all patients did well, showing no relapse. <br><b>Conclusion:</b> Surgery, along with antitubercular treatment, is the key to the management of GUTB presenting with structural damage. However, surgery can be ablative or reconstructive, depending on various factors discussed in the present study. This preserves or restores the optimal function of the genitourinary system affected by the mycobacterium bacilli.

Background: Genitourinary tuberculosis (GUTB) is a type of extrapulmonary TB that exerts a deleterious effect on renal function by promoting renal calcification and ureteric stricture. Therefore, we investigated the risk factors for chronic kidney disease (CKD) in GUTB patients after the end of treatment., Methods: This retrospective study was conducted at a tertiary hospital in South Korea. Data from patients (>18 years of age) with GUTB were collected from January 2005 to July 2016. CKD was defined as a glomerular filtration rate <60 mL/min/1.73m 2 after the end of treatment., Results: In total, 56 patients with GUTB (46.4% males; mean age 52.8 ± 16.6 years) were enrolled in the study. CKD developed in 11 (19.6%) patients and end-stage renal disease in 4 (7.1%). In a univariate analysis, older age (p = 0.029), microscopic haematuria (p = 0.019), proteinuria (p = 0.029), acute renal failure (ARF) (p < 0.001) and a positive polymerase chain reaction-based test result for TB in the urine (p = 0.030) were significantly associated with decreased renal function. In a multivariate analysis, ARF (odds ratio [OR], 54.31; 95% confidence interval [CI], 1.52-1944.00; p = 0.032) and old age (OR, 54.26; 95% CI, 1.52-1932.94; p = 0.028) were independent risk factors for CKD in GUTB patients., Conclusions: ARF and old age were independent risk factors for CKD in GUTB patients. Therefore, in elderly GUTB patients with ARF at the time of diagnosis, regular follow-up of renal function should be performed even after the end of treatment.

Aims: To demonstrate an association between female genital tuberculosis (FGTB) and endometriosis., Methods: A total of 16 women who underwent laparoscopy (12 cases) or laparotomy (4 cases) and were found to have female genital tuberculosis and endometriosis were enrolled in this retrospective study., Results: The mean age and parity were 28.2 years and 0.2, respectively. Past history of tuberculosis was present in 75% of the women (pulmonary in 50%). Menstrual dysfunction (especially oligomenorrhoea and dysmenorrhoea), constitutional symptoms, infertility, abdominal pain and lump were the main complaints. Diagnosis of FGTB was made by positive acid-fast bacilli (AFB) on microscopy, culture of endometrial aspirate, positive polymerase chain reaction (PCR), histopathological finding of epitheliod granuloma or findings of TB on laparoscopy or laparotomy. Diagnosis of endometriosis was made by laparoscopy or laparotomy. Pelvic adhesions were seen in all women, whereas frozen pelvis was seen in 7 (43.7%) women. Surgery was performed, which was laparoscopic adhesiolysis in 12 (75%), drainage of endometrioma in 12 (75%), cystectomy in 8 (50%), and total abdominal hysterectomy with bilateral salpingo-oophorectomy in 4 (25%) cases. With more then one type of (surgery in many cases)., Discussion: Female genital tuberculosis and endometriosis may have similar manifestations and can co-exist., (Copyright © 2017 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Unlabelled: The fourth, terminal, stage of bladder tuberculosis (BT) manifests itself in irreversible changes and requires surgical treatment., Objective: To identify the reasons for delayed diagnosis of this urogenital tuberculosis complication. Medical history of 26 urogenital tuberculosis patients with a complicated form of stage 4 BT, referred to the Novosibirsk TB Research Institute for reconstructive surgery were analysed. In 22 patients, bladder volume ranged from 55 to 100 ml, 4 patients previously underwent cystostomy due to extremely small bladder volume. Average duration of BT hidden in the guise of "urogenital infection" was 6.2 years. Patients were treated with norfloxacin (a total of 104 courses), ciprofloxacin (86 courses), amikacin (43 courses), nitroxoline (27 courses), third generation cephalosporins (32 courses), lomefloxacin (17 courses), levofloxacin (11 courses), Amoxicillin clavulanate (4 courses), ampicillin (2 courses). It was demonstrated that all cases of BT stage 4 were iatrogenic. Irreversible debilitating complications occurred due to suboptimal therapy, primarily due to administration of amikacin and fluoroquinolones for urogenital infections, which was tuberculosis in disguise. Absence of M. tuberculosis growth does not exclude tuberculosis; pathological specimens must be further examined at least by PCR. Interventional material must be mandatory examined histologically and stained by Ziehl-Neelsen method to identify M. tuberculosis. Effective and not masking tuberculosis, optimal therapy for urogenital infections includes fosfomycin, furazidin (nitrofurantoin), gentamicin, III generation cephalosporins (in outpatient settings dispersible form of efixime should be preferable).

Background and Objectives: Laparoscopy is the present standard of care for urologic diseases. Laparoscopy in renal tuberculosis (genitourinary tuberculosis) is difficult because of inflammation and fibrosis associated with the disease. We present the outcome of our experience of laparoscopy in genitourinary tuberculosis, both ablative and reconstructive., Methods: The detailed data of patients with genitourinary tuberculosis who underwent laparoscopic surgeries between January 2011 and September 2012 were reviewed. Indications, type of surgery, duration, blood loss, intraoperative problems, postoperative outcomes, and follow-up details were noted., Results: Overall, 7 laparoscopic procedures were performed: 5 nephrectomies, 1 ureteric reimplantation with psoas hitch, and 1 combined nephrectomy and laparoscopy-assisted Mainz II pouch reconstruction. The mean operative time was 192 minutes for nephrectomy, 210 minutes for ureteric reimplantation, and 480 minutes for nephrectomy with Mainz II pouch reconstruction. There were no conversions to open surgery. The mean amount of blood loss was 70 mL for the nephrectomies, 100 mL for ureteric reimplantation, and 200 mL for nephrectomy with Mainz II pouch reconstruction. In 5 of 6 patients who underwent nephrectomy, there was severe perinephric and peripelvic fibrosis posing difficulty in dissection. However, the renal vessels could be controlled individually. The mean postoperative hospital stay was 3 days for the nephrectomies, 5 days for the ureteric reimplantation, and 10 days for the nephrectomy with Mainz II pouch reconstruction. In all cases the recovery was uneventful., Conclusions: Laparoscopy, though technically more demanding, is a feasible and safe option for ablative and complex reconstructive procedures in genitourinary tuberculosis. It offers the benefits of minimally invasive surgery. The difficulty with this procedure is mostly because of peripelvic and perinephric fibrosis, whereas the lower ureter and bladder are relatively easier to dissect.

Tuberculosis continues to be a worldwide public health issue, known as "the great pretender" resembling many diseases. Overall 1% of women infected with Mycobacterium species develop genital tuberculosis (GT) which is widespread more commonly during their fertility age, 20-40 years old. GT is the second most common cause of extra pulmonary tuberculosis. One of the clinical manifestations in these patients is Infertility; with a poor prognosis of a successful pregnancy even with a correct diagnosis, medical and/or surgical treatment. Most pregnancies result in ectopic pregnancies or abortions. In low income countries GT may account for 5-20% of infertility cases. It was widely believed that pregnancy represented a period of risk to women infected with tuberculosis; and actually abortion is suggested. We report a case of a 21 year old female patient who came to the General Hospital Dr. Miguel Silva in the city of Morelia, Michoacán with the diagnosis of late puerperium postpartum complicated with retained placental tissue to perform a uterine curettage. The patient had fever and anemia for which we had to perform a laparotomy exploration of the doubt of uterin perforation; the surgical findings were pathognomonic of GT for which we continue to realize Hysterectomy. The macro and microscopically pathologic findings consists in GT, confirming the diagnosis with Ziehl-Neelsen acid stain. GT findings must always be differentiated from ovarian cancer.

Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary TB after lymph nodes. Advanced GUTB leading to strictures of ureters and urethra, and bladder contracture frequently need surgical management. These are usually treated by ileal replacement of ureter, substitution urethroplasty using buccal mucosal graft (BMG) and augmentation ileo-cystoplasty, respectively. These procedures have been well demonstrated individually but all these three procedures have never been combined as single procedure in the same patient. We report a case of advanced GUTB with ureteric and urethral strictures, and bladder contracture which was treated by the ileal replacement of ureter, augmentation ileo-cystoplasty combined with BMG substitution urethroplasty in a single sitting.

Objective: To report a case of adeno-carcinoma arising in an augmented bladder 41 years after the procedure., Methods: After troublesome evaluation and fistula closure with urinary diversion by percutaneous nephrostomy, the patient underwent palliative chemotherapy and radiotherapy., Result: He died 5 months after the onset of the fistula., Conclusions: Development of adenocarcinoma in augmentation enterocystoplasties implies a mortality of about 30%. Early detection requires a high index of suspicion. Surveillance of augmented bladders, by annual cystoscopy and urine cytology, is therefore recommended.

Objective: To document the management of tuberculous cicatrized urinary bladder by incorporating bowel segment and the long-term follow-up after the reconstructive surgery., Materials and Methods: Twenty-three patients (out of 28) were managed by augmentation cystoplasty (AC) and 5 by orthotopic neobladder (OTN) reconstruction. Sigmoidocystoplasty was performed in 11 cases, ileocystoplasty in 10 patients and ileocecocystoplasty in 2 patients. Ileal neobladder reconstruction was done in 2 patients, ileocecal neobladder reconstruction in 1 patient and sigmoid neobladder reconstruction in 2 patients, respectively. The patients were followed according to standard follow-up protocols., Result: The mean age of patients who underwent AC was 32.5 years and of those who underwent OTN reconstruction was 31 years. The mean pre-operative bladder capacity in patients with AC was 70 ml (range 40-100 ml) and of patients with OTN reconstruction was 14 ml (range 10-20 ml). The mean postoperative bladder capacity at 3 months following AC was 427 ml (range 450-500 ml) and following OTN reconstruction it was 430 ml (range 350-450 ml). The mean follow-up in patients who underwent AC was 43.3 months (range 12-90 months) and in those who underwent OTN reconstruction it was 35.6 months (16-60 months). None of the patients had upper urinary tract deterioration following the reconstructive surgery., Conclusion: Urinary bladder rehabilitation either by AC or OTN reconstruction increases the bladder capacity and storage time and also preserves the upper tracts.

Renal transplantation is the treatment of choice for patients with end-stage renal disease and it has already been described in the literature in patients with orthotopic neobladders, mostly in the paediatric population. We report the first case of a living-donor renal graft in an adult patient with a orthotopic neobladder that was performed after radical cystectomy for urinary tuberculosis and reflux nephropathy. This patient experienced urologic and metabolic complications since the early posttransplant period., (Copyright © 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: Genitourinary tuberculosis represent 3.2% of the possible sites of the disease. The lack of treatment or an inadecuate one may lead to severe complications. We report a case and review thoroughly the literature of genitourinary tuberculosis which needed a complete vesico-ureteral reconstruction., Clinical Case: A 39 year old female patient with history of pulmonary tuberculosis who had lumbar pain and left ureterohydronephosis. She required a percutaneous urinary derivation and was diagnosed of tuberculosis by means of the urine culture. 18 months afterwards she had a right renal annulation and a left distal ureteral stenosis. A right nephectomy was performed and the left proximal ureter was desinserted accidentally, 1 cm below the pielo-ureteral junction, which required a permanent nephostomy. Then her bladder became gradually retractile. Because she was a young patient and had bad quality of life a complete reconstruction of her left urinary way was performed with an ileum made neobladder and neoureter. DISCUSSION AND CONCLUSSIONS: Bladder and ureter reconstruction with ileum is a good option in difficult cases of lack or irreversible damage of the urinary way. Vesico-ureteral reconstruction letting urethral miction improves quality of life.

The results of radical nephrouretercystectomy (NUCE) are presented for 13 patients (9 males and 4 females, age 44-70 years, mean age 58 +/- 1.7 years). One-stage NUCE was made in 11 patients, two- or three-stage--in 2 patients. Indications for NUCE were the following: urothelial cancer, urogenital tuberculosis, microcystis, neurogenic dysfunction of the urinary bladder complicated by definite renal dysfunction. Postoperative complications arose in 3 patients. Lethal outcomes were absent. The results presented say in favour of extended surgery in involvement of the kidney, ureter, urinary bladder, prostate, urethra. Radical NUCE is primarily indicated in cancer of the renal pelvis, ureter with muscular invasion into the bladder wall, non-functional kidney due to ureteral obstruction with a tumor or scar.

We report a patient in Automatic Peritoneal Dialysis (APD) with tuberculous peritonitis by possible peritoneal infection due to the proximity between fallopian tube and the left ovary, a peritoneal liquid culture was constantly negative. The patient presented a bad clinic evolution. Her only medical history was hypercalcemia six months before developing a peritonitis and occasionally nausea and vomits To confirm the diagnosis it was needed a peritoneal biopsy by means of a laparoscopy with a removal of the peritoneal catheter and left anexectomy. Now, the patient is asintomatic in daily home hemodialysis.

Introduction: Genitourinary tuberculosis (GUT) is the third most frequent extrapulmonary tuberculous infection, following pleural and nodal involvement. Associated clinical symptoms are mild, and the diagnosis and treatment of this condition are often delayed., Methods: This study determines the clinical and epidemiological characteristics, and outcome of patients diagnosed with GUT in our center over the last 10 years. Patients with positive Löwenstein-Jensen urine or biopsy culture, or pathologic study suggestive of tuberculosis were included. Cases of multifocal tuberculosis and positive Löwenstein-Jensen, but with no urinary symptoms or radiological alterations, were considered to have mycobacteriuria., Results: Forty-five patients were analyzed (62% men; mean age, 49.4 years). Among the total, 33% had a coexisting disease (14 were infected by human immunodeficiency virus). Twenty-six patients (57%) had renal tuberculosis, 5 (11%) orchiepididymitis, and 14 (31%) were classified as having mycobacteriuria. The most frequent clinical manifestations were urination syndrome (61%), low back pain (44%), and macroscopic hematuria (12%). Ziehl stain was positive in 38% cases. Urine culture was positive for other microorganisms in 9 patients (20%). Intravenous urography oriented the diagnosis in 87.5% of cases. The average interval between onset of symptoms and diagnosis was 15 months. Cure without sequelae was obtained in 60%. Surgery was indicated in 10 patients., Conclusions: The index of suspicion for GUT should be high when patients present with repeated urinary syndromes. The current use of imaging studies other than urography and the finding of other microorganisms in urine culture can delay the diagnosis.

We report a case of adenocarcinoma arising in the urinary bladder 45 years after ileal replacement of ureter for tuberculous ureteral stricture. A 65-year-old man was admitted with gross hematuria. Cystoscopic examination demonstrated a broadbased non-papillary tumor on the left posterior wall of the bladder and a papillary tumor at the anastomotic site between the bladder and ileal segment. Total cystectomy and construction of ileal conduit were performed. The histopathological examination demonstrated well differentiated adenocarcinoma of the bladder and ileal ureter. Intestinal metaplasia widely infiltrated into the bladder epithelium around the anastomotic site.

Tuberculosis of the female external genitalia is unusual and primary infection is rare. We report a 50-year-old female patient admitted to Department to Surgery with swelling over left inguinal area with discharging sinus from labia majora to left inguinal crease which was found to be tubercular sinus on histopathology.

Tuberculosis (TB) is a deadly infectious disease. Pulmonary TB cases have decreased; yet, extrapulmonary cases such as genitourinary TB have not (Centers for Disease Control and Prevention, 2005). Health care awareness of the clinical features of genitourinary TB is necessary to effectively treat patients with this disease.

Purpose: We evaluated the role of surgery for genitourinary tuberculosis with special emphasis on reconstructive procedures., Materials and Methods: Case records of 241 patients with genitourinary tuberculosis who underwent surgery at our center during a period of 17 years were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied., Results: There were 129 males and 112 females with a mean age of 34.6 years. The most common presentation was irritative voiding symptoms. Azotemia was seen in 54 (22.4%) cases. The most commonly involved organ was the kidney in 130 (53.94%) cases. Preoperative bacteriologic diagnosis was confirmed in 70 (29%) cases. All patients received antitubercular drug therapy for 9 months. A total of 248 procedures, including 33 endoscopic, 87 ablative and 128 reconstructive, were performed with some patients requiring more than 1 procedure. Early complications, which mainly involved the bowel, were seen in 19 (7.88%) cases. Bacteriologic cure was achieved in all culture positive cases. Renal functional parameters stabilized or improved in 44 of 54 patients (81.5%) in whom they were deranged at presentation., Conclusions: Genitourinary tuberculosis is common in developing countries. Diagnosis is often delayed because of late presentation and many patients present with cicatrization sequelae. A combination of antitubercular drug therapy and judicious surgery achieves satisfactory results in the majority of cases. With improved antitubercular drug therapy and experience with the use of bowel segments in the urinary tract, more reconstructive procedures are being performed with satisfactory outcomes. In patients who undergo reconstructive procedures, a rigorous and prolonged followup is necessary.

Background: Tubercular cold abscess of the seminal vesicle is very rare, and only a few cases are reported in literature. Preoperative diagnosis is difficult and to the best of our knowledge has not been reported., Case Report: A 35-year-old man presented with a 7-year history of blood in the semen and a reddish brownish discharge per urethra while defecating. On rectal examination, a soft fluctuant mass was felt above the prostate. Abdominal ultrasonography showed cystic swelling of the right seminal vesicle bulging into the posterior bladder wall. Semen examination showed abundant pus cells and 90% immotile sperm with normal morphology. Acid-fast bacilli were not seen, but acid-fast bacilli were found in a 24-hour urine specimen. Cystoscopy showed tubercles in the urethra and brownish discharge from the orifice of the right ejaculatory duct on per-rectal compression of the mass. The abscess cavity was incised with a Collings' knife. Brownish material was evacuated, and the abscess cavity was seen. An 18F Foley catheter was placed for 3 days. Antitubercular therapy was instituted. Ultrasonography repeated after 3, 25, 45, and 75 days showed gradual regression of the abscess cavity. Semen examination after 75 days was normal, with 75% motility, and cystoscopy 45 days postoperatively showed complete healing of the wound., Conclusion: The incision connecting the bladder with the abscess cavity facilitated evacuation of pus and complete resolution of the abscess.

We describe in detail the technique of laparoscopy-assisted ileal ureter creation for multiple tuberculous ureteral strictures in two patients. The proximal anastomosis included an ileocalicostomy in the first patient and an ileopyelostomy in the second patient. The first patient had bowel entrapment behind the mesentery of the ileal loop, but the second patient had an uneventful postoperative recovery. Short-term follow-up showed good patency of the ileal loop. The variations in the technique that can cause postoperative problems are discussed, and the future of this technique is postulated.

Aims: Clinical and urodynamic evaluation of the late outcome of 25 patients with chronic tuberculous cystitis who underwent bladder augmentation., Patients and Methods: Twenty men and five women with median age of 40 years were evaluated. The tubularized ileocecal segment was used in 8 cases, the detubularized sigmoid in 13, and the tubularized sigmoid in 4. Patients underwent a postoperative clinical and urodynamic evaluation. Miccional diurnal frequency of more than 2 hr together with patient satisfaction as assessed by the quality of life question of the ICSmaleSF questionnaire was considered a good result., Results: The average postoperative follow-up was of 11.1 +/- 9.1 (1 to 36) years. A good result was seen in 80% of the patients. Bad results occurred statistically in the cases using tubularized sigmoid and in patients with prostatitis. Patients with good results showed augmented bladders with normal sensation (P = 0.03) and greater capacity (P < 0.01) and compliance (P < 0.01) than did those with bad results. There was no statistically significant difference in the frequency of involuntary contractions (P = 0.27) but in the good result patients, the contractions started with greater bladder filling volume (P = 0.02)., Conclusions: The sigmoid should be detubularized but the ileocecal segment may be used in its original tubularized form to augment the bladder with chronic tuberculous cystitis. Augmented bladder with capacity of more than 250 ml, good compliance, and normal sensation are necessary for diurnal frequency of more than 2 hr. The presence of involuntary contractions does not lead to a decrease in the diurnal frequency.

A 60-year-old woman visited our hospital complaining of fever up. She had undergone augmentation ileoplasty for tuberculous bladder atrophy 43 years age. Cystoscopy revealed a broadbased tumor on the ileal segment. Histopathological findings of the biopsy specimen demonstrated grade 3 transitional cell carcinoma. She was given 2 courses of chemotherapy (methotrexate, vincristine, adriamicin, cisplatin), but died of metastasis of carcinoma 4 months after diagnosis.

Nearly one third of the world's population is estimated to be infected with Mycobacterium tuberculosis. Moreover, tuberculosis is the most common opportunistic infection in AIDS patients. Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Drug treatment is the first line therapy in genitourinary tuberculosis. Treatment regimens of 6 months are effective in most of the patients. Although chemotherapy is the mainstay of treatment, surgery in the form of ablation or reconstruction may be unavoidable. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy.

Objective: We reviewed our surgical experience on genitourinary tuberculosis in the past 20 years in order to evaluate if any change in the incidence and management of this disease has occurred., Patients and Methods: From 1980 to 1999, at our Institution, 102 patients underwent surgery for genitourinary tuberculosis. We recorded the data and the surgical procedure of these subjects and compared patients treated in period 1980-1989 to those submitted to surgery in the period 1990-1999., Results: The overall incidence of surgical management of genitourinary tuberculosis in the past 20 years was 0.50% (102 cases on a total of 20,299 urological surgical procedures). In the decade 1980-1989 the incidence was 0.67% (70 cases out of 10,428 patients) and in the decade 1990-1999 it was 0.32% (32 cases out of 9,871 patients). Nephrectomy was the most prevalent surgical procedure performed in both decades., Conclusions: Despite the availability of effective antimycobacteric drugs, surgery continues to play a role in the management of genitourinary tuberculosis. This disease is very slow to progress with minimal and subtle symptoms, often resulting in irreversible damage of the organs involved by the time a diagnosis is established.

Most tumors arising after augmentation ileocystoplasty have been reported to develop adjacent to the ileovesical anastomosis. Herein, we report a case of adenocarcinoma arising at the ileoileal anastomotic site 33 years after augmentation ileocystoplasty (Scheele's ring plasty) for tuberculous contracted bladder. The present case shows the possibility of late malignancy developing at the ileoileal junction after ileal neobladder.

A 47-year-old man visited our hospital with a complaint of a right intrascrotal mass. The results of a laboratory examination were unremarkable. An ultrasonographic examination of the right scrotum demonstrated a low echoic legion, 2.5 x 1.3 x 0.7 cm in diameter. A right spermatic cord tumor was diagnosed. Right high orchiectomy was performed. Microscopic examination showed a granulomatous lesion with Langhans large cells. Tuberculin skin test was strongly positive. From these findings we diagnosed the patient with tuberculosis in the spermatic cord.

The development of cancer on the ileal graft after augmentation ileocystoplasty for benign bladder disease is a little known complication. The authors report a case of squamous cell carcinoma in the ileal bladder occurring 37 years after augmentation ileocystoplasty for tuberculous bladder, in a 68-year old patient. Carcinomatous degeneration is usually occurs more than ten years after cystoplasty. Patients treated by this operation must be submitted to annual cystoscopy combined with guided biopsies at the slightest doubt. This surveillance should be started between the 5th and the 10th postoperative year.

The effects of regeneration of the urinary bladder on the intestinal transplant were assessed in conducting detrusor resection after creation of an artificial reservoir for urine in 107 patients with posttuberculous microcystis. It was found that the condition of the intestinal transplant depended on severity of anatomic changes and the scope of detrusor resection. The best results of creation of a new artificial reservoir for urine are achieved if the bladder, as a cause of regenerative process and unfavourable factor for operation outcome is totally removed.

Objectives: To assess the surgical and long-term results of renal transplantation in 25 patients with bladder dysfunction and augmentation cystoplasty., Methods: We retrospectively reviewed the evolution and surgical outcome of 25 renal transplants in 24 recipients with augmentation cystoplasty. The mean patient age at transplantation was 27.6 years. The etiology of bladder dysfunction was neurogenic bladder with detrusor hyperreflexia (11 patients), tuberculosis (5 patients), vesicoureteral reflux (4 patients), posterior urethral valves (3 patients), and interstitial cystitis (1 patient). Seventeen transplants were from living donors. Augmentation cystoplasty was performed before transplantation in 21 patients. The bowel segments used in the augmentation cystoplasty included ileum in 16, ileocecal segments in 2, and sigmoid in 5 patients. The donor ureter was anastomosed to the native bladder in 16 patients, to the bowel segment in 6, and to the native ureter in 3., Results: Twenty kidneys (80%) were functioning at a mean follow-up of 53.2 months (range 6 to 118). The mean serum creatinine was 1.56 mg/dL (range 0.7 to 2.6). Three patients died of unrelated causes and 1 of adenocarcinoma that originated at the vesicointestinal anastomosis. The actuarial graft survival at 1, 2, and 5 years was 96%, 92%, and 78%, respectively. Complications included symptomatic urinary infection, ureteral stenosis, and lymphocele., Conclusions: Augmentation cystoplasty is a safe and effective method to restore function in noncompliant bladders. Renal transplantation can be performed safely after augmentation cystoplasty.

Genitourinary tuberculosis is an important cause of morbidity in developing and developed countries. We describe a case of extensive genitourinary tuberculosis in which there was complete destruction of the right kidney, stricture of the entire left ureter and an autocystectomized bladder. He presented in azotemia with urinary incontinence and was managed by right nephroureterectomy, ileal replacement of left ureter and ileal neobladder after a preliminary nephrostomy and antituberculous chemotherapy.

Objective: To outline the pattern and trends in major cases of genito-urinary tuberculosis (GUTB) which require hospital treatment., Method: We retrospectively reviewed 55 patients with proven GUTB who were treated as in-patients in a major referral hospital in Pakistan., Results: The male/female ratio was 3:1. Prevailing symptoms were lower urinary tract symptoms, flank pain, gross hematuria and fever. A urine culture was positive for tuberculosis (TB) in 57%, bladder biopsies in 54%. For renal TB, intravenous urogram (IVU) and ultrasound were suggestive in about 50% of cases. Ultrasound was very helpful in the diagnosis of testicular TB. Patients underwent surgery in 36% of cases. In contrast to the general trend reported worldwide, surgery was mainly ablative rather than re-constructive. Patient compliance in clinical follow-up and drug therapy was poor., Conclusion: Surgery for GUTB in Pakistan is still mainly ablative, probably due to a high number of complicated and progressed cases. To date, therapy of GUTB is mainly based on anti-tuberculosis chemotherapy (ATT). However, huge efforts will be required to improve patient compliance without which every therapeutic approach will remain futile.

Tuberculosis in children involves many organs and systems including lymphatics, lungs, CNS, GIT and genitourinary. Although the mainstay of treatment is medical, surgery has a definite role under specific circumstances. It is important to differentiate atypical mycobacterial infection wherein surgery is the primary modality of treatment. The lung is most commonly involved in tuberculosis and besides bronchoscopy, thoracic procedures range from tube thoracostomy to decortication and lung resection. Neurotuberculosis constitutes almost half the cases of extrapulmonary tuberculosis and tuberculous meningitis (TBM) is the commonest type of CNS involvement. Hydrocephalus is a late complication of TBM and shunt surgery is indicated when signs and symptoms of raised intracranial pressure persist despite adequate medical therapy. Abdominal tuberculosis could be peritoneal or gastrointestinal. Either form can complicate the other and each can present in acute, subacute or chronic form. Surgical therapy is reserved for complications like strictures, fistulae and GI bleed. Genitourinary tuberculosis constitutes 15-20% of all extrapulmonary disease and epididymitis is the most common manifestation in the males. Surgery is generally reserved for management of complications such as ureteral strictures, perinephric abscesses and nonfunctioning kidneys.

Arthur Jacobs (1899-1974) was the father of urology in Glasgow. His extensive experience with genitourinary tuberculosis, ureterosigmoidostomy, and bladder augmentation were far ahead of his time. He became an expert in retropubic prostatectomy and was a pioneer in early imaging techniques.

Objectives: To describe the indications and long-term results of orthotopic bladder replacement for tubercular thimble bladders., Methods: Four patients (3 women, 1 man; mean age 32 years) presented with markedly contracted bladders of tubercular etiology. The patients had marked lower tract symptoms, and the mean bladder capacity was 15 mL. All 4 patients had associated upper tract pathology. Four-drug antitubercular treatment (ATT) was started in all 4 patients, and all 4 underwent surgery 4 weeks later. The procedure performed was a cystectomy and orthotopic bladder reconstruction using the ileocecal segment in 3 patients and the sigmoid colon in 1. The ureters were implanted into the taenia of the cecum or the sigmoid in an antireflux fashion. ATT was continued for a total of 9 months., Results: All patients had an uneventful postoperative course. After a follow-up period ranging from 22 to 54 months (mean 38), the average bladder capacity in the 4 patients was 450 mL (range 400 to 600). The mean maximal flow rate was 18.3 mL/s. Potency was preserved in the man and all patients were continent at last follow-up. The male patient had hypercontinence requiring clean intermittent catheterization for a period of 3 months. At last follow-up all patients had residual-free micturition. The female patients were able to void to completion with a Valsalva maneuver. No patient had symptomatic urinary infection or deterioration in renal function. No patient had persistent ureteral reflux or stricture., Conclusions: Cystectomy with orthotopic bladder replacement offers an alternative to the urologist treating end-stage tubercular bladders (thimble bladders) with a capacity of less than 15 to 20 mL. This treatment removes the source of the symptoms, permits anastomosis to healthy tissue of the proximal urethra, and addresses lower ureteral pathology at the same time. The long-term results in these initial cases are encouraging; however, only a prospective, randomized trial can establish whether these advantages actually translate into long-term clinical benefit in this group of patients.

Combined treatment using low-intensity laser radiation (LILR) was performed in 125 patients with urinary tuberculosis: 54 patients had combined intravascular blood laser radiation (IBLR) and external renal laser radiation, 71 patients were exposed to IBLR with an AZOR-2K device. The use of LILR in the combined treatment contributed to the stabilization of a specific process, to significant renal functional improvement, and a reduction of a postoperative period from 26 to 20 days.

The paper deals with the efficiency of various operations on the urinary system. It emphasizes a strict approach to surgical interventions by taking into account the functional status of the kidneys, the magnitude of chronic renal failure, the need for antibiotic therapy in the pre- and postoperative periods.

A 53-year-old female was admitted to our hospital after right hydronephrosis was found on the CT scan taken at another hospital. The urinary cytology and culture findings as well as the urinary culture for acid-fast bacilli results were all negative. At our hospital, CT scan revealed a thickening of the right ureteral wall, and right hydronephrosis. In spite of the fact that retrograde pyeloureterography showed a right ureteric obstruction at the ureterovesical junction, cystoscopic examination demonstrated a normal bladder. Since right lower tract carcinoma was suggested, we performed right nephroureterectomy with bladder cuff. Histopathological diagnosis, however, revealed renal and ureteral tuberculosis.