Tuberculosis

Tuberculosis of the kidney is usually caused by hematogenously spread organisms. Initial treatment involves antituberculous drugs such as isoniazid, rifampin, pyrazi-namide, and ethambutol. Nephrectomy is indicated in cases of nonfunctioning kidneys, with extensive disease involving the entire kidney, causing hypertension, uretero pelvic junction obstruction, or coexisting renal carcinoma. Lee et al. reported the largest series of laparoscopic nephrectomy for tuberculosis of the kidney (16). Outcomes of laparoscopic nephrectomy in 31 patients with nonfunctioning kidney secondary to tuberculosis were compared to those of 45 patients who underwent laparo-scopic nephrectomy for other benign causes. In the tuberculosis group, 10 were performed using the transperitoneal approach and 21 via the retroperitoneal approach. On comparing the tuberculosis group and the nontubercular group, no difference was noted as regards operative time (206 minutes vs. 200 minutes), length of hospital stay (5.3 days vs. 5.7 days), and complication rates (13% vs. 7%). There was one open conversion in the tuberculosis group.

Laparoscopic nephrectomy for tuberculosis is safe and, with sufficient laparo-scopic experience, appears to provide the same benefits as for other benign noninflammatory conditions.

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