Treatment of Ureteral Stricture and Contacted Bladder Due to Tuberculosis

Kim, Kee Soo

Abstract

Renal tuberculosis, if not treated surgically, usually runs a fatal course. In discussion as to whether a tuberculous kidney should be treated surgically or medically, most of the urologist, Dr. Wildolz. Rafin. Nesbit. agree with the opinion that nephrectomy is the radical treatment for tuberculosis of the kidney is early stage. Since those new drugs. PAS, and isoniazid including streptomycin, have been used for renal tuberculosis, the seriousness of renal tuberculosis is decreased compared with before. But the great tendency to scarring and contracture develops in the urinary pathway as a result of the disease or secondary to the healing of the tuberculous process. Cicatrization or scarring of the ureters, or the bladder exerts a serious influence on renal function, the death of the patient with renal tuberculosis is therefore frequently due to the sequelae of this infection rather than tuberculosis itself. I present seven patients seen in the short period of three years who, after nephrectomy and during medical therapy, suffered serious damage to the remaining normal kidney because of bladder or ureteral disease those were assumed that both kidneys would be damaged by tuberculosis in clinical investigation. In the treatment of those seven patients, I have observed tuberculous stricture of the ureter at any levels from the kidney to the bladder in five cases whose each remaining kidneys were found to be healthy and to become hydronephrotic due to stricture of the ureter, and other two were contracted bladder due to tuberculosis. In five patients of ureteral stricture, four cases restored normal renal function with reimplantation of the ureter into bladder and in one case uretero-ileocystoplasty as ileal replacement in three cases. one case was failed in ileal replacement. A patient with contracted bladder with very severe symptoms was markedly improved by constructing author's a new technique of two layer open-flap ileocystoplasty to enlarge the capacity of the bladder. The other patient was given a ringplastic ileocystoplasty, whose bladder symptoms were as much as before with significant residual urine in late period on five months after operation in spite of improvement in early period.