Intestinocystoplasty in tuberculosis of the urinary bladder.

Abstract

Introduction. Genitourinary tuberculosis (GUTB) ranks second in the structure of extrapulmonary forms in Russian Federation. Reconstructive surgery for GUTB is required for cases with grossly distorted and dysfunctional anatomy that are unlikely to regress with chemotherapy alone. In the recent past, there has been a tremendous increase in the variety of reconstructive procedures for the urinary bladder, used in the management of GUTB. Materials and methods. The search, analysis and systematization of publications in the databases PubMed, Scopus, Web of Science, Google Scholar, e-Library.ru according to the following keywords «tuberculosis of the genitourinary system», «cystoplasty», «gastrocystoplasty», «ileocystoplasty», «cecocystoplasty», «iliocecocystoplasty», «sigmocystoplasty», «orthotopic non-bubble». As a result, 41 publications were selected to write the review. Results and discussion. Augmentation cystoplasty includes the goals of increasing bladder capacity, while retaining as much of bladder as possible. Various gastrointestinal segments have been used for bladder reconstruction. The choice of material for reconstruction is purely the surgeon's prerogative his skill, the ease, the mobility and length of mesentery (allowing bowel to reach the bladder neck without tension and maintaining an adequate blood supply). The presence or absence of concomitant reflux is of considerable importance. In the former, an ileocystoplasty with implantation of ureter to the proximal end of the isolated ileal loop and anastomosis of the distal end of the ileal loop to the bladder neck and trigone is advocated. In the latter case, the ureterovesical valve is preserved and colocystoplasty is preferred, wherein the sigmoid colon on being opened along its antimesenteric border is joined to the trigone and bladder neck and then to itself to form a capacious pouch. Gastrocystoplasty reduces the risk of acidosis but is associated with complications like hypochloremic alkalosis and «hematuria-dysuria» syndrome. Orthotopic neobladder reconstruction is a feasible option, suitable in cases of tubercular thimble bladder with a markedly reduced capacity (as little as 15 ml), where an augmentation alone may be associated with anastomotic narrowing or poor relief of symptoms. Conclusions. In this article, we review the various bladder reconstruction options used for the surgical management of GUTB, along with their indications and complications.