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.
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: