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CASE REPORT
Year : 2003  |  Volume : 20  |  Issue : 1  |  Page : 71-72
 

Tubercular autocystectomy with vesico­colic fistula - a case report


Department of Urology, Sir JJ Hospital, Mumbai, India

Correspondence Address:
Percy Jal Chibber
Department of Urology, Sir JJ Hospital, Byculla, Mumbai - 400 008
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Genitourinary tuberculosis, cystocolic, fistulae.


How to cite this article:
Shah HN, Bokil AA, Chibber PJ. Tubercular autocystectomy with vesico­colic fistula - a case report. Indian J Urol 2003;20:71-2

How to cite this URL:
Shah HN, Bokil AA, Chibber PJ. Tubercular autocystectomy with vesico­colic fistula - a case report. Indian J Urol [serial online] 2003 [cited 2019 Jun 17];20:71-2. Available from: http://www.indianjurol.com/text.asp?2003/20/1/71/37136



   Case Report Top


A 52-year-old male, previously diagnosed as a case of abdominal Kochs, presented with acute retention of urine. As a urethral catheter could not be passed, a suprapubic catheterization was done. He had a serum creatinine of 2.4mg/dL and an ultrasound showed bilateral gross hydro­ureteronephrosis and a thick bladder wall. The patient later had an internal urethrotomy for a discrete bulbar stricture. He was asymptomatic for 6 months postoperatively, after which he presented with acute renal failure and symptoms of passing urine perrectum. Urethral catheterization failed.

Ultrasound showed bilateral pyonephrosis with dilated ureters. The urinary bladder could not be demonstrated. Bilaternal percutaneous nephrostomies (PCN) were per­formed. Ascending urethrogram revealed an irregular di­lated posterior urethra opening into a very small bladder from which there was prompt reflux up the left ureter and leak of contrast into the sigmoid colon [Figure - 1]. On left nephrostogram a vesico-colic fistula was demonstrated between the sigmoid colon and the bladder. Right nephro­stomy was draining pus approximately 50cc/day. Panen­doscopy revealed normal anterior urethra, but the bladder could not be identified and irrigating fluid filled the rec­tum easily. His serum creatinine stabilized at 1.6mg/dL after bilateral nephrostomy drainage. CT scan of abdo­men and pelvis showed right hydronephrotic kidney with the PCN tube insitu. There was no excretion of contrast on the right side while the left side was normal. The blad­der could not be identified in the pelvis. His colonoscopy was normal. On exploration no bladder tissue was identi­fied. The posterior urethra opened into a small cavity, which had a fistulous communication with sigmoid co­lon. A right nephroureterectomy was done and left ureter anastomosed into an ileal conduit. The fistulous tract was excised and the sigmoid colon was closed primarily with a proximal transverse loop colostomy. Histopathological examination of the excised fistulous tract showed fibrosis with typical tuberculous granuloma. He received anti Koch's treatment and the colostomy was closed after 3 months. Patient is on regular follow-up for the last 3 years and has a stable renal function with a serum creatinine of 1.4 mg/dL and a healthy urinary stoma.


   Comments Top


This case represents a rare variety of genitourinary Koch's where the patient developed total destruction of bladder over a period of 7 months to the extent that intra­operatively it was completely replaced by dense fibrous tissue. This occurred after starting medical therapy for abdominal tuberculosis. There was spontaneous vesico­colic fistula with sigmoid colon.

Tuberculous autonephrectomy is a well described en­tity where there is complete destruction of the kidney; usually silent and asymptomaitc. Auto-prostatectomy has been described in literature; however this entity is ex­tremely rare. Thimble bladder is commonly seen in genito­urinary tuberculosis, especially after antitubercular treatment has been started and frequently requires surgi­cal treatment, either augmentation cystoplasty or urinary diversion. However to our knowledge there has been no reported case of complete destruction of the bladder; for which we suggest the term tuberculous autocystectomy.

Psihrams reported a case of primary genitourinary tuber­culosis associated with severe progressive scarring and destruction of left kidney with contracted bladder, per­sistent vesicoureteral reflux and bulbar urethral stricture where scarring started after initiation of medical therapy. [1] A close supervision was advised after initiation of therapy for genitourinary tuberculosis. Pereiva-Arias et al de­scribed a case of advanced genitourinary tuberculosis and recommended early diagnosis and treatment in order to avoid the irreversible sequelae. [2]

 
   References Top

1.Psihrams KE, Donahoe PK. Primary genitourinary tuberculosis - rapid progression and tissue destruction during treatment. J Urol 1986; 135(5): 1033.  Back to cited text no. 1    
2.Pereira-Arias TG, Gallego Sanchez JA, Larvinage-Simon J, Prieto­Ugidos-N, Gonzalez-Ibarluzea-J, Bernuy Malfaz-C. Advanced tu­bercular disease of urogenital tract. Arch Esp Urol 1997; 50(4): 396.  Back to cited text no. 2    


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