Treatment of Urinary Tract Tuberculosis with Ureteral Stenosis and Hydronephrosis
This protocol covers the management of ureteral (urinary tract) stenosis arising from tuberculosis, where obstruction leads to hydronephrosis and places renal function at risk.
Clinical Scenario
Ureteral stenosis due to tuberculosis causes progressive obstruction and hydronephrosis. When kidney function preservation is necessary, early urinary diversion — via double-J catheter or nephrostomy — is indicated before pharmacological treatment is started.
Surgical Approach (Partial Overview)
When endoscopic management is not feasible or has failed, reconstructive surgery — open, laparoscopic, or robotic — is indicated. The full protocol specifies which technique applies based on the location and extent of ureteral involvement.
The complete technique selection algorithm, indications by ureteral segment, and the full structured regimen are available in the protocol below.
References
- DOI: 10.1590/S1677-5538.IBJU.2024.0590
- In the presence of ureteral stenosis due to tuberculosis, a double-J catheter or nephrostomy should be used early (up to 1 month), before the beginning of pharmacological treatment, in cases in which kidney function preservation is necessary (GRADE: moderate, strong).
- For cases of complex strictures (those with multiple strictures greater than 2 cm in size or the impossibility of passing through a guidewire) or failure of endoscopic treatment, traditional open, laparoscopic or robotic reconstructive surgery should be performed (GRADE: low, strong).
- In the event of endoscopic treatment failure or strictures greater than two centimeters, traditional open, laparoscopic or robotic reconstructive surgery should be performed.
View source ↗