GASTRIC NEOBLADDER FOR TREATMENT OF TUBERCULOSIS CYSTITIS

Abstract

A 72-year-old man with a severely contracted bladder due to tuberculous cystitis had gross hematuria and urge incontinence. Urinalysis, urine culture and complete blood count were normal. Urea and creatinine were 49 mgJdl. (normal 20 to 40) and 1.7 mgJdl. (normal 0.7 to 1.41, respectively. Chest x-ray was normal. Excretory urogram revealed normal kidneys but the ureters were stenosed at the ureterovesical junctions and the bladder was severely contracted. Cystoscopy revealed a normal urethra but decreased bladder capacity (50 cc). Mucosa of the bladder had a grayish brown a p pearance. No gross pathology was seen elsewhere. Biopsy taken from the bladder revealed granulomatous reaction and necrosis (tuberculous cystitis). After 4 weeks of antituberculosis drug therapy, cystectomy and bladder replacement, using a wedge of stomach, were performed instead of bladder augmentation. We used the procedure of Mitchell et al with some modification.2 We did not use a cystostomy catheter for irrigation but the patient had a 3-way, indwelling catheter for 3 weeks. Convalescence was uneventful. After removal of the catheter, the patient was able to void without marked difficulty. Antituberculosis drug therapy was continued for 6 months. Bladder capacity increased to 250 cc postoperatively. Complete blood count, urea (33 mgJdl.), creatinine (0.8 mgJdl.), urine culture and serum gastrin (139 pgJml., normal 200 or less) were normal at 2-year followup. Since ranitidine had been prescribed not long after surgery, dysuria or hematuria symptoms were not noted. Two years later the patient presented with symptoms of overflow incontinence and cystoscopy revealed a normal ure-