SURGICAL CARE FOR PATIENTS WITH DISSEMINATED AND COMPLICATED UROGENITAL TUBERCULOSIS

Summary. Renal tuberculosis becomes a surgical disease if not diagnosed in time or if therapy is inadequate. Reconstructive surgery preserves renal function, but is traumatic for the patient when performed openly. Choice of method depends on the initial kidney function. Material and methods. The effectiveness of minimally invasive surgical techniques was evaluated in 134 patients with disseminated and complicated nephrotuberculosis undergoing treatment in the urogenital department of the Federal State Budgetary Institution of the Scientific Research Institute of the Ministry of Health of the Russian Federation. We performed a comparative analysis of the results of open (51 patients) and laparoscopic (42 patients) access operations for complicated and disseminated nephrotuberculosis.Results. In operations performed laparoscopically, the duration of the need for narcotic analgesics was 13 times shorter than in open surgery.The patient could be activated by an average of 2.4±0.6 hours after laparoscopic surgery, and 38.7±8.6 hours after open surgery. The complication rate for laparoscopic surgery was 2.64 times lower (OR=3.83; 95% CI 1.12-10.22).An orthotopic bladder in patients with stage 4 bladder tuberculosis provides an average reservoir capacity of 226.7±24.3 ml in all 47 patients 2 weeks after surgery and increases to 258.3±36.7 at 6 weeks after surgery. Free painless urination by the third month after surgery was noted in 91.5% of patients. Among the patients operated on by us, 5 (9.8%) out of 51 patients had contraindications for the orthotopic bladder formation - the patients underwent heterotopic urinary diversion.Conclusion. The use of laparoscopy at different stages of surgical intervention allows reducing traumatism of the intervention while maintaining its radicality.