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Surgical management of renal tuberculosis

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      Abstract

      Tuberculosis (TB) is one of the major health problems that our country is facing today. Despite active interventions by our government, control of TB still remains to be achieved. The emergence and exponential growth of the human immunodeficiency virus and drug-resistant strains threaten to further complicate the TB situation in our country. Even in this era of advanced chemotherapy, many lives are lost every day in our country. Tuberculosis of the urinary tract, despite being one of the commonest forms of extra-pulmonary TB, is generally overlooked. Most patients present with vague lower urinary symptoms typical of urinary tract infection. In this article, we shall highlight the various issues related to the surgical management of renal and ureteral tuberculosis.

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      Most cited references 39

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      Management of tuberculosis in the United States.

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        EAU guidelines for the management of genitourinary tuberculosis.

         Mete Cek,  Kurt Naber,   (2005)
        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.
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          Genitourinary manifestations of tuberculosis.

          By the 1980s, the availability of antituberculosis chemotherapy reduced the incidence and prevalence of tuberculosis. Changing patterns of population emigration and the development of large pools of immune-compromised individuals reversed the downward trend of tuberculosis. The incidence of genitourinary tuberculosis has remained constant. The manifestations of GU TB can be variable and cause a variety of clinical patterns that mimic other diseases. Adrenal insufficiency, renal disease, obstructive uropathy, and chronic cystitis are not uncommon with TB. The patient with TB may have genital disease that simulates STD or scrotal tumors. Infertility can be caused by GU tuberculosis. Awareness of environmental factors and patient history should alert the urologist to the wide array of clinical findings in the genitourinary system that can be caused by tuberculosis.
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            Author and article information

            Affiliations
            Department of Urology, Christian Medical College, Vellore, India
            Author notes
            For correspondence: Dr. Ganesh Gopalakrishnan, Department of Urollogy, Christian Medical College, Vellore, Tamil Nadu, India. E-mail: ganeshgopalakrishnan@ 123456yahoo.com
            Journal
            Indian J Urol
            IJU
            Indian Journal of Urology : IJU : Journal of the Urological Society of India
            Medknow Publications (India )
            0970-1591
            1998-3824
            Jul-Sep 2008
            : 24
            : 3
            : 369-375
            2684360
            19468471
            IJU-24-369
            10.4103/0970-1591.42620
            © Indian Journal of Urology

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Symposium

            Urology

            nephrectomy, hydronephrosis, renal tuberculosis

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