Urogenital tuberculosis is a type of extra pulmonary tuberculosis mainly caused by the organism mycobacterium tuberculosis. It can affect any structure in the genital or urinary tracts, although it has a propensity to initially affect the kidneys.
Urogenital tuberculosis (UGTB) or genitourinary tuberculosis (GUTB) constitutes 14-41% of extra-pulmonary tuberculosis (TB) . It is mediated by hematogenous spread from a primary pulmonary infection, which is often asymptomatic and becomes latent. Latent infections can remain inactive for up to 40 years. Reactivation of the same occurs when a host is immunocompromised, this explains the higher incidence of TB and GUTB among those with human immunodeficiency virus (HIV). It is estimated that as many as 75% of individuals with GUTB also have HIV . Other factors that weaken the immune system include diabetes mellitus, chronic steroid use and malnutrition.
The prevalence of GUTB is twice as high in men than in women, and the average age of diagnosis is within the fourth decade . Due to the insidious onset of non specific symptoms, diagnosis is challenging . For the same reasons, affected individuals delay seeking medical attention .
It is believed that among the first sites to be infected in the genitourinary system are the kidneys, seminal vesicles, and prostate glands . Consequently, the infection spreads locally. Frequent complaints include urinary symptoms such as flank and lower abdominal pain, frequency, dysuria and gross hematuria. Urinalysis may reveal microscopic hematuria and sterile pyuria. Constitutional symptoms of TB, that is, fever, weight loss, anorexia, are rarely seen on presentation. Moreover, almost half of patients with genital TB remain asymptomatic  .
Urinary tract structures involved include the kidneys, ureters, bladder and urethra. Renal involvement is often unilateral, resulting in sub-clinical renal injury and eventually chronic renal failure. In the genital tract, TB may affect the prostate gland (causing hematospermia and pain), seminal vesicles, epididymis, testes and both male and female external genitalia. Possible complications include loss of fertility, sexual dysfunction, urinary tract strictures, fistula formation and hypertension secondary to renal disease.
Entire Body System
(cystitis) Symptoms of kidney infection (pyelonephritis) Smelly urine Passing urine frequently Urgency (a pressing need to pass urine) Pain in your lower abdomen (tummy) Pain in your urethra (waterpipe) Bloodstained urine Fever Shaking (rigors) and chills [baus.org.uk]
Urgency and dysuria are seen in cystitis and fever, chills, flank pain, nausea and vomiting, frequency, urgency, dysuria, and elevated sedimentation rate (>30 mm/hr) are typical for acute pyelonephritis. [anaerobicinfections.blogspot.com]
Fever or chills Previous renal or urinary dx tests or use of indwelling catheters Dysuria & when it occurs during voiding (at initiation or termination of voiding) Hesitancy, straining, or pain during, after urination 5. Urinary Incontinence [slideshare.net]
Malaise, fevers, and chills are also common in affected patients. Voiding problems are usually absent when only the external genitalia are involved. However, associated renal, vesical, or prostatic TB may contribute to irritative voiding symptoms. [emedicine.medscape.com]
Patients may be asymptomatic or may present acutely with chills, fever, ascitis, and sometimes, rebound tenderness. In the plastic variety, one may observe symptoms suggestive of partial intestinal obstruction. [glowm.com]
The laboratory findings included hematuria (27.3%), pyuria (12.1%), and hematuria with pyuria (48.5%). [ncbi.nlm.nih.gov]
Every third patient complained of flank pain and dysuria (accordingly 35.2% and 39.8%), 17% presented toxicity symptoms, 9.1% - renal colic, 7.9% - gross-hematuria. MBT was found in 31.8% in isolated kidney TB as whole. Sterile pyuria was in 25%. [erj.ersjournals.com]
The author proposes that any patient presenting with gross hematuria, persistent microscopic hematuria or pyuria, recurrent urinary tract infection, and persistent irritative micturition symptoms be investigated for urogenital tuberculosis, with six urine [asmscience.org]
Frequent complaints include urinary symptoms such as flank and lower abdominal pain, frequency, dysuria and gross hematuria. Urinalysis may reveal microscopic hematuria and sterile pyuria. [symptoma.com]
The onset of TB orchiepidydydmitis was in 35.7%, hemospermia - in 7.1%, dysuria - in 35.7%. Most common complaints for prostate TB were perineal pain (31.6%), dysuria (also 31.6%), hemospermia (26.3%). [erj.ersjournals.com]
The acute onset of tuberculous orchiepididymitis was seen in 35.7% of patients, hemospermia in 7.1%, and dysuria in 35.7%. [ncbi.nlm.nih.gov]
Urinary frequency Dysuria Loin discomfort Malaise and general symptoms of tuberculosis UlcerHowever, the infection arises insidiously, being potentially asymptomatic for a long period of time. [en.wikipedia.org]
- Vaginal Bleeding
Women might experience infertility, pelvic pain and unexplained vaginal bleeding. Patients with urinary TB might or might not have general symptoms of tuberculosis. [livestrong.com]
Female genital TB presents with infertility (and may be otherwise asymptomatic), pelvic pain, and vaginal bleeding. [cochranelibrary.com]
- Urinary Incontinence
[…] dx tests or use of indwelling catheters Dysuria & when it occurs during voiding (at initiation or termination of voiding) Hesitancy, straining, or pain during, after urination 5. Urinary Incontinence (stress intolerance, urge incontinence, overflow [slideshare.net]
A number of imaging and laboratory studies are available for the diagnosis of genitourinary tuberculosis. While laboratory studies are useful in establishing the presence of GUTB infection, imaging studies are what provide further information on the exact location of disease as well as what structures are affected. Mycobacteria are usually detected in urine by acid-fast bacilli (AFB) smear, as well as urine culture, which have variable sensitivity and specificity. Culture provides a delayed diagnosis, as it takes several weeks to obtain results, however it is currently the gold standard for diagnosis of GUTB. In contrast, the tuberculin test, while rapid, is less useful and accurate, as a negative result does not rule out TB infection . Further tests may incorporate histopathologic analysis of tissue samples, and polymerase chain reaction (PCR) of urine samples. The latter is both rapid and highly accurate  .
Imaging studies include:
- Chest X-ray: Only a minority of patients with GUTB will have positive radiographic findings of TB at the time of presentation .
- Intravenous urogram (IVU): This is the preferred imaging tool, in the assessment of renal disease.
- Pelvic and abdominal ultrasound.
- Computerized tomography (CT) and magnetic resonance imaging (MRI).
The laboratory findings included hematuria (27.3%), pyuria (12.1%), and hematuria with pyuria (48.5%). [ncbi.nlm.nih.gov]
The author proposes a periodic urine examination for hematuria or pyuria in patients with previous pulmonary tuberculosis or immunosuppressed subjects. [asmscience.org]
Sterile pyuria was in 25%. The onset of TB orchiepidydydmitis was in 35.7%, hemospermia - in 7.1%, dysuria - in 35.7%. Most common complaints for prostate TB were perineal pain (31.6%), dysuria (also 31.6%), hemospermia (26.3%). [erj.ersjournals.com]
- Granulomatous Tissue
Hypercalcemia may occur, usually secondary to abnormal cortisol production by granulomatous tissue.  Although calcification is unusual in the early stages of the disease, nearly every end-stage tuberculous kidney contains calcification. [ijri.org]
His symptoms improved within a few days of initiating treatment. Six months after treatment started, CT revealed a nonfunctioning right kidney and a functional left kidney with areas of scarring. [ncbi.nlm.nih.gov]
Treatment of Urogenital Tuberculosis Standard treatment of tuberculosis: Standard antituberculostatic treatment is done with isoniazid + rifampicin + pyrazinamide + ethambutol for 2 months. [urology-textbook.com]
The highly developed preventive and social medicine of Israel has excellent results, and prognosis is more than favorable. Only one death was registered in our material, and this was due to renal failure of long duration. [ncbi.nlm.nih.gov]
Merkel cell carcinoma of the genitourinary tract is an uncommon tumor that has an aggressive course with a poor prognosis, similar to its counterpart in the skin. [medical-dictionary.thefreedictionary.com]
[…] normally presents concurrently with pulmonary TB Clinical features Diagnosis Sepsis tuberculous accutissima (Landouzy septicemia, typhobacillosis of Landouzy) Description: septic progression of primary TB in an immunocompromised patient with a very poor prognosis [amboss.com]
The ultimate prognosis is determined by the degree of systemic illness. [emedicine.medscape.com]
Tubal surgery has a poor prognosis. [glowm.com]
[…] manifestations due to the underlying etiology. [icd10data.com]
Pathogen host: predominantly humans Mycobacterium bovis : Common pathogen causing gastrointestinal tuberculosis Mechanism of infection: predominantly via ingestion of contaminated cow's milk Pathogen reservoir: predominantly cattle References:   Etiology [amboss.com]
Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics. 1977;59(4):557-61 19. Dhua AK, Borkar N, Ghosh V, Aggarwal SK. Renal tuberculosis in infancy. J Indian Assoc Pediatr Surg. 2011Apr;16(2):69-71 20. [degruyter.com]
Etiology of Urogenital Tuberculosis Causative agent of tuberculosis: Mycobacterium tuberculosis is a 1–2 microns long immobile bacillus. Other features include: acid-resistant, intracellular persistence in phagocytes, doubling time 20 hours. [urology-textbook.com]
Etiology and management of genitourinary tuberculosis. Nat Rev Urol 2011;8:678-88. [ Crossref ] [ PubMed ] Figueiredo AA, Lucon AM. Urogenital Tuberculosis: Update and review of 8961 cases from world literature. [tau.amegroups.com]
Male genital tuberculosis: epidemiology and diagnostic. World journal of urology. 2012;30(1):15-21. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. [vestnik.szd.si]
OBJECTIVES: To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan. METHODS: A questionnaire was sent to the urological departments of 1203 Japanese hospitals. [ncbi.nlm.nih.gov]
Tuberculosis - diagnosis Tuberculosis - management Epidemiology © 2013 ERS [erj.ersjournals.com]
Epidemiology It usually strikes young adults with tuberculosis in other places of the body as well. [ipfs.io]
PURPOSE: To assess the radiological findings of urogenital tuberculosis (UGT) in patients at different disease stages, for a better understanding of its pathophysiology. [ncbi.nlm.nih.gov]
Brenner/Rector remains the go-to resource for practicing and training nephrologists and internists who wish to master basic science, pathophysiology, and clinical best practices. [books.google.com]
Risk factors for active tuberculosis: Immigrants Alcoholism Old age AIDS Diabetes mellitus Steroid therapy Intravenous drug abuse Smoking Lung diseases: Silicosis, COPD Malnutrition Malignant diseases Gastric resection Crowding, e.g. prisons Pathophysiology [urology-textbook.com]
References:    Pathophysiology Clinical features Latent infection Asymptomatic The patient is not contagious. [amboss.com]
This two-part article is a comprehensive review of the epidemiology, pathophysiology, and imaging findings in renal TB. [ijri.org]
Author information 1 Radiology Unit, Department of Diagnostic Medicine and Prevention, St. [ncbi.nlm.nih.gov]
Treatment and prevention Regular treatment with praziquantel from an early age prevents schistosomiasis from progressing to genital damage and other related complications. [who.int]
Centers for Disease Control and Prevention (CDC) (2002 August 13, Reviewed). Frequently Asked Questions, Questions and Answers about TB. National Center for HIV, STD and TB Prevention Division of Tuberculosis Elimination [On-line information]. [labtestsonline.it]
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