Tuberculosis surgery

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Overview

Surgery may be necessary, especially to drain spinal abscesses or to stabilize the spine in case of Pott's disease.

Surgery

Renal tuberculosis

Surgery is necessary to remove the urinary obstruction in genito urinary tuberculosis. 3 most common sites which can cause urinary obstruction is as follows.

• Pelvi- ureteral junction
• Calyx
• Lower end of ureter

Types of surgery	Proceedure
Cavernotomy	It involves removal of avascular caeseous material which helps in preventing complications like abscess rutputre. It has got excellent prognosis
Partial nephrectomy	This was an old technique to remove the affected tissue. Recently the drug regimen helps to heal the calyx and hence partial nephrectomy is not widely practised now.
Nephrectomy	Chief indication of nephrectomy is obstruction of pelvi-ureteric junction. Plastic surgery of pelvi uretric junction is also an option for it. Drianage improves the treatment
Excsion of stricture and reimplantation of ureter into the bladder.	This is another conservative surgical management which has shown promising results.

Spinal tuberculosis

• Biopsy is used to make a diagnosis.
• Gross instabillity and neurological complications are treated by decompression and fusion of the anterior segments.
• Joint damage may be repaired by late surgery and arthrodosis.

The main stay of treatment for skeletal tuberculosis is antibiotics and surgery. The selection of antibiotics for skeletal tuberculosis is the same as that of pulmonary tuberculosis.

Stage	Treatment
Stage 1 (synovitis)	Chemotherapy    Rest    Restriction of movements    Splinting
Stage 2 (Early arthritis)	Chemotherapy    Rest    Restriction of movements    Splinting    Synovectomy
Stage 3 (Advanced arthritis)	Chemotherapy    Osteotomy    Arthrodesis    Arthroplasty
Stage 4 (Advanced arthritis)	Chemotherapy    Osteotomy    Arthrodesis    Arthroplasty
Stage 5	Chemotherapy    Osteotomy    Arthrodesis    Arthroplasty