title: Urinary Tuberculosis with Renal Failure: Challenges in Management.
abstract: BACKGROUND
  India is the country with the highest burden of TB, an estimated incidence figure of 2.1 million cases of TB for India out of a global incidence of 9 million according to World Health Organization (WHO) statistics for 2013. Renal impairment in these patients is slow and due to continuous infection causing destruction of renal mass. Reconstruction of urinary tract which is frequently required for patients with Urinary TB poses significant challenges. This paper analyses these challenges.
  
  
  OBJECTIVE
  To analyse challenges in reconstruction of urinary tract in patients with urinary tuberculosis and renal failure.
  
  
  METHODS
  Thirty-one patients with renal tuber-culosis were seen from August 2011 to August 2013. We faced major problem in outcomes of surgery in patients with multifocal disease.
  
  
  RESULTS
  Out of 31 patients 18 patients were males and 13 were females. Total 11 patients had serum creatinine more than 2mg/dl (1.5 mg/dl being upper normal range of our laboratory) at the time of presentation. These patients had simultaneous kidney, ureter and bladder involvement or with bilateral disease. Four of these patients underwent uretero-calicostomy, five patients underwent augmentation cystoplasty with bilateral ureteric reimplantation and two patients underwent ileal conduit as they were having serum creatinine of more than 2.5 mg/dl. All patients who underwent ureterocalicostomy had re stricture and failure of surgery and augmentation cystoplasty had raised creatinine requiring second procedure in the form of percutaneous nephrostomy. Patients with ileal conduit remained stable with overnight bladder drainage at bed time.
  
  
  CONCLUSIONS
  Though renal failure is not considered contrain-dication for augmentation cystoplasty, reconstruction using large segment of bowel predisposes them to metabolic complications and sepsis. Use of short segment of ileal conduit with continued drainage at night in creatinine above 2.5 mg% is reasonable option for augmentation to avoid further metabolic complications.
authors.affiliation: Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India .
authors.forename: Vinayak Gorakhanath
authors.initials: VG
authors.lastname: Wagaskar
authors.affiliation: Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India .
authors.forename: Rahul Arun
authors.initials: RA
authors.lastname: Chirmade
authors.affiliation: Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India .
authors.forename: Vidyasagar Hansraj
authors.initials: VH
authors.lastname: Baheti
authors.affiliation: Resident, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India .
authors.forename: Harshawardhan Vedpalsingh
authors.initials: HV
authors.lastname: Tanwar
authors.affiliation: Professor and Head, Department of Urology, King's Edward Memorial Hospital and S.G.S. Medical College , Mumbai, India .
authors.forename: Sujata Kiran
authors.initials: SK
authors.lastname: Patwardhan
authors.affiliation: Professor and Head, Department of Urology, Vedanayagam Hospital , Coimbatore, India .
authors.forename: Ganesh
authors.initials: G
authors.lastname: Gopalakrishnan
keywords: Augmentation cystoplasty; GUTB; Ileal conduit; Uretero-calicostomy