Invasive Procedures Used in Tuberculosis with Questionable Indications: Report from Russia

Surgical treatment of tuberculosis has been applied in the former Soviet Union more frequently than in other countries. On the contrary to the international practice, tuberculoma cases have been often operated on. There was a decreasing tendency since the last decades; but the surgery rate is still comparatively high. Surgeries were sometimes performed without preceding chemotherapy. Among others, an argument in favor of the early surgery was non-compliance increasing with time. Compulsory treatments of patients with Tb and/or alcoholism are discussed here. The factors predisposing to the use of invasive procedures with questionable indications included the partial isolation from international scientific community, insufficient consideration of the principles of informed consent, professional autonomy and scientific polemics, as well as paternalistic attitude to patients. The message of this review is that patients should not undergo operations to comply with doctrines. Evidence-based clinical indications must be determined individually.