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RESEARCH ARTICLE
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 19-23

Is contralateral renal involvement in genitourinary tuberculosis primary?


SGPGIMS, Lucknow, India

Correspondence Address:
A Mandhani
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014
India
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Source of Support: None, Conflict of Interest: None


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Objective: To know whether contralateral involvement in genitourinary tuberculosis is primary or sequential to the involvement of the bladder. Methods: Retrospectively from June 1989 to Jan 1998 and then prospectively till Dec 2002, patients of genitourinary tuberculosis were reviewed. Of 147 patients complete record with follow up was available in 117. Diagnosis was considered proven only on the presence of one major and or two minor criteria. Major criteria were granulomatous lesion on histopathology, AFB positivity in urine or histopathology and a positive PCR. Minor criteria were changes suggestive of tuberculosis on intravenous urography, hematuria, raised ESR and or pulmonary changes of old Koch's lesion. Patients were grouped as group 1 (N=64) with renal involvement only, Group 2 (N=20) with renal and reversible bladder involvement and group 3 (N=33) with tubercular contracted bladder (capacity <250m1). Laterality and degree of involvement (grade I, single calyceal involvement, grade II more than one and grade 3, involvement of the ureter on intravenous urogram or Nephrostogram) were recorded. Results: There was no difference in patient age, symptoms, positive urine culture for Acid fast bacilli in all 3 groups. Bilateral involvement was present in 23 (19.6%) patients and all the cases were in group 3. Of these, contra lateral lower ureteric stricture was present in 12 and vesico­ureteric reflux in 11 patients. None of these 23 patients on imaging showed calyceal changes in contra lateral kidney suggestive of primary hematogenous involvement. The only finding was pelvicalyceal dilatation, which was a consequence of reflux or backpressure changes. At a mean follow up 46.8±34.2 months no patient developed complication in the contra lateral kidney in terms of calyceal deformity and ureteric stricture. Conclusions: As the involvement of the contralateral ureter is through the bladder, diagnosis of bilateral lower ureteric tubercular stricture in absence of contracted bladder should be made with caution. This fact would help in minimizing intervention on the contra lateral low grade reflux and prognosticating the reversibility of function in patients with renal impairment.


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