Should bladder tuberculosis be treated with medication or surgery?

When it comes to the treatment of bladder tuberculosis, it is actually not much different from the treatment of kidney tuberculosis, and it is still mainly based on drugs. However, many patients choose to undergo surgery, and the effect is not worse than drug treatment. This makes many bladder tuberculosis patients feel troubled. Is it better to choose drug treatment or surgical treatment?

1. Drug treatment

There are many drugs with clinical application value, but isoniazid, streptomycin, and salicylic acid have better efficacy and lower toxicity, and are called first-line drugs. Other drugs such as thiosemicarbazide, pyrazinamide, kanamycin, cycloserine, and viomycin are not as effective as first-line drugs and are more toxic. They are only used when tuberculosis bacteria develop resistance to first-line drugs, so they are called second-line drugs. Rifampicin and ethambutol are newer drugs. Due to their higher efficacy and lower toxicity, they have tended to replace salicylic acid and be listed as first-line drugs in recent years.

2. Surgical treatment

Effective drug therapy has changed the status of surgical treatment. Many cases that previously required surgical treatment can now be treated with non-surgical methods. However, a retrospective study by Fischer found that even after an average of 9 months of anti-tuberculosis treatment, fresh tuberculosis lesions were still visible in 52% of surgical specimens. Therefore, surgery still has an important position. As for the timing of surgery, it is generally recognized that it should be performed 4 to 6 weeks after regular anti-tuberculosis treatment. There are also many surgical methods. According to Gow's statistics in 1981, among all surgical procedures, resection surgery has gradually decreased, and reconstructive surgery has increased accordingly. The surgical method can be considered according to the damage to the diseased kidney: lesion removal, partial nephrectomy, nephrectomy, etc. Regardless of the type of surgery used, medication should still be continued after surgery and the above-mentioned criteria should be followed for discontinuation of medication.