Urinary tract tuberculosis
ICD-10 A18.1; N33.0 · ICD-11 1B12.5

Treatment of Urinary Tract Tuberculosis with Contracted Bladder (Capacity 20–100 mL)

Tuberculosis of the urinary tract can lead to a markedly contracted bladder. When bladder capacity falls below 100 mL, surgical intervention is indicated to restore adequate voiding function and protect the upper urinary tract.

Clinical scenario: Contracted bladder due to tuberculosis with a capacity of at least 20 mL and less than 100 mL, in the absence of associated pelvic pain.

Surgical approach

Management involves enlarging the bladder using a segment of intestine. The segment selected and how it is prepared both influence functional outcomes. In patients with ureteral involvement, additional ureteral surgery may be required. The full protocol details segment selection, technical preparation criteria, and the specific indications for ureteral intervention.

Treatment goals

  • Voiding intervals of two hours or more
  • Preservation of the upper urinary tract
  • Spontaneous voiding without the need for self-catheterization
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References

DOI: 10.1590/S1677-5538.IBJU.2024.0590

In patients with bladder tuberculosis, bladder augmentation with an intestinal segment is indicated when the bladder capacity is less than 100 mL (GRADE: moderate, strong).

In patients with very small bladders (capacity less than 20 mL) or in those with UGT associated with pelvic pain, cystoprostatectomy and an orthotopic neobladder may be considered (GRADE: very low, weak).

When bladder augmentation or orthotopic neobladder surgery is performed, the ileum, sigmoid and ileocecal segments can be used. Detubularization and reconfiguration of the intestinal segment should be performed, but the ileocecal segment can be used in its original form without detubularization (GRADE: low, weak).

Ureteral reimplantation is indicated in patients with ureteral stricture but may not be performed in patients with reflux (GRADE: low, strong).

In this study, good results (voiding interval greater than or equal to two hours) were associated with the use of an ileocecal segment without detubularization and a sigmoid segment with detubularization.

Spontaneous voiding occurs in most patients after bladder augmentation.

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