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Tuberculous stricture of ureter — Clinical Guidelines

Overview

Tuberculous stricture of the ureter is a complication of tuberculosis affecting the urinary tract, leading to narrowing and potential obstruction of the ureter, often requiring surgical intervention or endoscopic management. 6

Diagnosis

Imaging studies (CT urography, ultrasound) to identify stricture location and extent 6

Ureteroscopy for direct visualization and biopsy if necessary 6

Urine analysis and culture to confirm tuberculosis presence 6

Management

Endoscopic dilation: Repeated dilation to maintain patency 6

Stent placement: Temporary or long-term ureteral stenting to relieve obstruction 6

Surgical repair: Reconstructive surgery (e.g., Boari flap, psoas hitch) for refractory cases 6

Antitubercular therapy: Concurrent administration of multi-drug regimen (e.g., INH, rifampicin, pyrazinamide) for tuberculosis management 6

Special Populations

Pediatrics: Management often requires careful consideration of growth and development; endoscopic approaches preferred initially 6

Elderly: Increased risk of complications; conservative management with stents or minimally invasive procedures recommended 6

Comorbidities: Presence of other conditions may influence choice between endoscopic and surgical interventions; close monitoring essential 6

Key Recommendations

Utilize high-fidelity training models for resident proficiency in ureteroscopy techniques to enhance real-life surgical outcomes (Evidence: Moderate 4 6)

Incorporate virtual reality simulators for foundational training in basic ureteroscopy skills, correlating VR performance with cadaver model proficiency (Evidence: Moderate 7 9)

Employ 3D printed models as cost-effective training tools for flexible ureteroscopy, ensuring practical skills acquisition (Evidence: Weak 2)

Ensure accurate cost estimation training for disposable devices used in ureteroscopy to optimize resource management (Evidence: Weak 3)

Integrate automated fluid management systems in training to familiarize practitioners with modern surgical technology (Evidence: Moderate 5)

References

1 van Rooyen MC, Sujee N, Adam A. Prior video game exposure and ureteroscopic skill: correlation or coincidence?. World journal of urology 2025. link 2 Trelles Guzmán CR, Mainez Rodríguez JA, Aguado-Maestro I, Cansino Alcaide R, Pérez-Carral JR, Martínez-Piñeiro L. 3D printed model for flexible ureteroscopy training, a low-cost option for surgical training. Actas urologicas espanolas 2022. link 3 Farber NJ, Chuchvara N, Modi PK, Sterling J, Elsamra SE. Urologists' estimations of the cost of commonly used disposable devices. The Canadian journal of urology 2019. link 4 Cloutier J, Traxer O. Do high-fidelity training models translate into better skill acquisition for an endourologist?. Current opinion in urology 2015. link 5 De S, Torricelli FC, Sarkissian C, Kartha G, Monga M. Evaluating the automated Thermedx Fluid Management System in a ureteroscopy model. Journal of endourology 2014. link 6 Olweny EO, Pearle MS. Update on resident training models for ureteroscopy. Current urology reports 2011. link 7 Chou DS, Abdelshehid C, Clayman RV, McDougall EM. Comparison of results of virtual-reality simulator and training model for basic ureteroscopy training. Journal of endourology 2006. link 8 Matsumoto ED, Kondraske GV, Ogan K, Jacomides L, Wilhelm DM, Pearle MS et al.. Assessment of basic human performance resources predicts performance of ureteroscopy. American journal of surgery 2006. link 9 Ogan K, Jacomides L, Shulman MJ, Roehrborn CG, Cadeddu JA, Pearle MS. Virtual ureteroscopy predicts ureteroscopic proficiency of medical students on a cadaver. The Journal of urology 2004. link

Tuberculous stricture of ureter