Role of Early Endourologic Management of Tuberculous Ureteral Strictures

Abstract

BACKGROUND AND PURPOSE: Tuberculous ureteral stricture causing progressive obstructive uropathy commonly complicates renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral strictures. PATIENTS AND METHODS: Seventy-seven patients (84 renal units) with tuberculous ureteral strictures were analyzed. We evaluated the final outcome of involved kidneys with three different managements: medication only (N = 37), medication plus ureteral stenting (N = 28), or medication plus PCN (N = 19). RESULTS: The overall nephrectomy rate was 51%. In patients treated with medication only, the nephrectomy rate was 73%, whereas the nephrectomy rate was 34% in patients treated with medication plus early ureteral stenting or PCN. The rate of reconstructive surgery for ureteral strictures also was significantly different for patients treated with medication only (8%) and those receiving medication plus early ureteral stenting or PCN (49%). Spontaneous resolution of the strictures was noted in 6 of the 12 renal units that were managed with early ureteral stenting. CONCLUSIONS: Early ureteral stenting or PCN in patients with tuberculous ureteral strictures may increase the opportunity for later reconstructive surgery and decrease the likelihood of renal loss.