Introduction: Genitourinary tuberculosis (GUTB) ranks second in the structure of extrapulmonary forms in Russian Federation. Reconstructive surgery for GUTB is required for cases with grossly distorted and dysfunctional anatomy that are unlikely to regress with chemotherapy alone. In the recent past, there has been a tremendous increase in the variety of reconstructive procedures for the urinary bladder, used in the management of GUTB.

Materials and methods: The search, analysis and systematization of publications in the databases PubMed, Scopus, Web of Science, Google Scholar, e-Library.ru according to the following keywords «tuberculosis of the genitourinary system», «cystoplasty», «gastrocystoplasty», «ileocystoplasty», «cecocystoplasty», «iliocecocystoplasty», «sigmocystoplasty», «orthotopic non-bubble». As a result, 41 publications were selected to write the review.

Results and discussion: Augmentation cystoplasty includes the goals of increasing bladder capacity, while retaining as much of bladder as possible. Various gastrointestinal segments have been used for bladder reconstruction. The choice of material for reconstruction is purely the surgeon's prerogative his skill, the ease, the mobility and length of mesentery (allowing bowel to reach the bladder neck without tension and maintaining an adequate blood supply). The presence or absence of concomitant reflux is of considerable importance. In the former, an ileocystoplasty with implantation of ureter to the proximal end of the isolated ileal loop and anastomosis of the distal end of the ileal loop to the bladder neck and trigone is advocated. In the latter case, the ureterovesical valve is preserved and colocystoplasty is preferred, wherein the sigmoid colon on being opened along its antimesenteric border is joined to the trigone and bladder neck and then to itself to form a capacious pouch. Gastrocystoplasty reduces the risk of acidosis but is associated with complications like hypochloremic alkalosis and hemahturia-dysuria» syndrome. Orthotopic neobladder reconstruction is a feasible option, suitable in cases of tubercular thimble bladder with a markedly reduced capacity (as little as 15 ml), where an augmentation alone may be associated with anastomotic narrowing or poor relief of symptoms.

Our experience includes 148 patients (51.4% men and 48.6% women, mean age 53.5 ± 1.8 years) who underwent surgery due to tuberculous contracted bladder during 21-year period. Ileocystoplasty was performed in 105 patients, sigmocystoplasty in 35, gastrocystoplasty in 6, and ileocecocystoplasty in 2. Nephrectomy as the first stage of treatment was performed in 126 (85.4%) patients. In 42 cases, augmentation cystoplasty was supplemented by ileoureteroplasty, and in 38 patients, the ureter was reimplanted into the intestinal portion of the neobladder. The follow up period was from 6 months to 21 years. Early complications were made in 10 patients (6.8%), the most common of which were adhesive intestinal obstruction (5 - 3.4%) and intestinal anastomotic leakage (5 - 3.4%). Mortality rate was 1.3% (n=2). In both cases death occurred due to severe cerebrovascular accident approximately 1 month after surgery. In the late postoperative period 17 patients (11.5%) required surgical intervention. Late postoperative complications requiring surgical correction were: urinary retention (6 patients - 4.1%), ureteroenteric stenosis (6 - 4.1%)), and pouch-vesical anastomosis (5 - 3.4%).

Conclusions: Augmentation cystoplasty is a successful long-term solution for patients with tuberculous contracted bladder (volume <100 ml). The surgery relieves lower urinary tract symptoms, prevents deterioration of renal function, and is well-tolerated, resulting in satisfactory long-term results. Orthotopic reconstruction of the tuberculous bladder can be used when its volume decreases to 15 ml or less, accompanied by severe dysuria, suprapubic pain, and ureteral involvement. However, these procedures require strict long-term monitoring of blood electrolyte levels and renal function, urinary microflora, possible recurrence of tuberculosis infection, residual urine volume, and the development of hydroureteronephrosis.

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