Urogenital tuberculosis can lead to severe bladder contracture, reducing functional capacity to critically low levels. When bladder capacity falls below 20 mL, or when urogenital tuberculosis is associated with pelvic pain, standard bladder-conserving approaches may be insufficient and a different surgical pathway becomes relevant.
This protocol applies to patients with a very small bladder — capacity less than 20 mL — or to those with urogenital tuberculosis (UGT) presenting with pelvic pain. These findings signal a degree of end-organ involvement that warrants specific surgical consideration beyond conservative management.
In this setting, surgical reconstruction involving removal of the affected bladder and creation of a urinary reservoir using an intestinal segment may be considered. The full protocol details which segments are appropriate and how they are configured.
DOI: 10.1590/S1677-5538.IBJU.2024.0590
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).
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