Laparoscopic ablative and reconstructive surgeries in genitourinary tuberculosis.
OBJECTIVE
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.
Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India.
Rahul
R
Gupta
Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India.
Lalgudi N
LN
Dorairajan
Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India.
K
K
Muruganandham
Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India.
Ramanitharan
R
Manikandan
Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India.
Avijit
A
Kumar
Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India.
Santosh
S
Kumar
D000328:Adult; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D014401:Tuberculosis, Urogenital / Q000601:surgery*; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*
Genitourinary tuberculosis; MAINZ II; laparoscopy; nephrectomy; ureteric reimplantation