The Management of Genito-Urinary Tuberculosis

¹ New York, New York

(1) Urogenital tuberculosis is of hematogenous origin and is never primary.

(2) Tuberculosis is not limited to the genitourinary tract; therefore close cooperation with the internist is essential.

(3) Miliary lesions may cause tubercle bacilluria with normal pyelographic findings.

(4) Healing of renal tuberculosis by calcification ("true autonephrectomy") or by slough of caseous material rarely occurs.

(5) The commonly employed cleansing and sterilizing agents fail to remove acid-fast bacilli from ureteral catheters, a possible source of diagnostic error.

(6) Bilateral retrograde pyelography is not contraindicated in tuberculosis.

(7) Sanatorium care is important, pre- and postoperatively.

(8) Surgical details of nephrectomy and ureterectomy include: proper preparation, anesthesia, transfusion, oxygen therapy and atraumatic technic (rib resection, removal of perirenal fat, ureterectomy).

(9) Sinuses, fistulas, amyloidosis, cystitis, meningitis, postoperative spreads and bilateral renal tuberculosis are discussed.

(10) Cutaneous ureterostomy plays an important role as a palliative procedure.

(11) Nephrostomy has been found to be safe and beneficial when indicated.

(12) Genital tuberculosis occurred in 14.4 per cent of male autopsies, of which 95.2 per cent showed prostatic involvement.

(13) Medical treatment of genital tuberculosis is unsatisfactory.

(14) Radical removal of the entire genital tract (Young) appears logical for patients with a satisfactory pulmonary status. No favorable case has been admitted on our service.

(15) Epididymectomy or orchidectomy is advisable to prevent traumatizing of these exposed tuberculous foci.

(16) Surgery for the tuberculosis of the external genitals requires attention to anesthesia, prevention of spillage, removal of sinus tract, preservation of blood supply, proper dependent drainage, and satisfactory scrotal support.