Functional Results of Operation for Distal Ureteral Stricture in Renal Tuberculosis

Abstract

Thirteen patients with renal tuberculosis complicated by distal ureteral stricture were followed up as regards the bacteriologic, roentgenographic, and functional results of chemotherapy combined with ureteral resection.

The urine was in every case freed of tubercle bacilli during the treatment and has remained so subsequently.

Postoperative urography showed improved contrast excretion in every instance, and a decrease in the dilatation of the renal pelvis and ureter in most of them. Micturition urethrocystography after the operation revealed vesico-ureteral reflux in eight of the thirteen patients.

The function of each kidney was studied by determining the clearance of inulin and of para-aminohippuric acid (PAH). The PAH-extraction was also determined in ten cases. In five cases the clearance values on the side previously strictured lay between the mean value and the normal lower limit for one of two healthy kidneys. In the remaining eight patients the values lay below the latter limit, showing function to be appreciably reduced. As the filtration fraction lay within normal limits in every instance, this suggests that filtration and tubular function are equally affected in reduced kidney function. The PAH-extraction was normal in most patients so examined, inferring that the function of remaining nephrons was well preserved.

The study shows that in renal tuberculosis complicated by ureteral stricture chemotherapy combined with operation of the stricture may secure permanent healing of the tuberculosis as well as an often considerable improvement from the urographic standpoint. It would seem that the functional end result is greatly dependent upon the extent to which the renal parenchyma has been destroyed before the patient comes to diagnosis and treatment. As uninvolved portions of the parenchyma may retain qualitatively good function for a long time, the approach in these cases should be as conservative as possible. Nephrectomy should be considered only when the destruction of the kidney is very advanced.