Tubercular ureteric strictures.
OBJECTIVE
To review the presentation of tubercular ureteric strictures and assesses the role of balloon dilatation and open surgical repair in their management.


METHODS
This was a retrospective review of tubercular ureteric strictures managed between January 1993 and December 2002. The records were analyzed to assess clinical presentation and compare the results of balloon dilatation with open surgical repair. Success was defined as adequate drainage on imaging, no worsening of renal function, no recurrence of symptoms and no requirement of intervention on further follow up. The long term success rates were compared using the t-test for proportion.


RESULTS
Of 73 strictures, 88% had lower urinary tract symptoms. Genital abnormalities suggestive of tuberculosis was observed in 40% male patients. Urine examination yielded aseptic pyuria in 85%, positive AFB smears in 36% and positive AFB cultures in 32%. A small capacity bladder and non-functioning renal units were the only consistent findings on intravenous urogram. Nephrectomy was performed in 37% cases due to non salvageable kidneys at presentation. The success rate of stenting fell from 93% on immediate follow up to 59% on a follow-up of 12 months. At 90% success rates on a follow-up of 7 months open surgical repair was superior (p 0.03). Long term success following balloon dilatation in renal units with good function was 78% compared to 25% for poorly functioning units. (p= 0.01)


CONCLUSIONS
Open surgical repair is superior to balloon dilatation in the management of tubercular ureteric strictures. Renal function may predict the success of balloon dilatation.
Sinha
Maneesh
M
Department of Urology, Christian Medical College, Vellore, India.
Chacko
K N
KN
Kekre
N S
NS
Gopalakrishnan
Ganesh
G
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014401:Tuberculosis, Urogenital / Q000150:complications* / Q000628:therapy; D014517:Ureteral Obstruction / Q000209:etiology* / Q000628:therapy; D013520:Urologic Surgical Procedures / Q000379:methods