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Urogenital Tuberculosis

Genitourinary TB

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.


Presentation

Urogenital tuberculosis (UGTB) or genitourinary tuberculosis (GUTB) constitutes 14-41% of extra-pulmonary tuberculosis (TB) [1]. 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 [2]. 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 [3]. Due to the insidious onset of non specific symptoms, diagnosis is challenging [4]. For the same reasons, affected individuals delay seeking medical attention [5].

It is believed that among the first sites to be infected in the genitourinary system are the kidneys, seminal vesicles, and prostate glands [6]. 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 [7] [8].

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.

Chills
  • (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]
Perineal Pain
  • The most common complaints for prostate tuberculosis were perineal pain (31.6%), dysuria (also 31.6%), and hemospermia (26.3%). MTB in prostate secretion/ejaculate was revealed in 10.5% of this group.[ncbi.nlm.nih.gov]
  • Most common complaints for prostate TB were perineal pain (31.6%), dysuria (also 31.6%), hemospermia (26.3%). MBT in prostate secretion / ejaculate was revealed in this group in 10.5%. Conclusion. UGTB is a heterogeneous disease.[erj.ersjournals.com]
  • Of men with prostatic TB, 50% have dysuria and 40% have perineal pain. Sterile urethral discharge and terminal hematuria may herald TB prostatitis. Perineal pain, swelling, and drainage can account for a less common but more overt presentation.[emedicine.medscape.com]
Respiratory Insufficiency
  • In chronic cases: respiratory insufficiency due to increasing fibrosis, amyloidosis, and caverns carcinoma. Miliary tuberculosis: hematogenic generalization in a poor immunological state.[urology-textbook.com]
Suprapubic Pain
  • Symptoms were irritative bladder symptoms such as dysuria and diurnal or nocturnal frequency (51.5%), flank pain (27.3%), microscopic hematuria (18.2%), gross hematuria (9.1%), and suprapubic pain (9.1%).[ncbi.nlm.nih.gov]
  • The most common symptoms of GUTB, in descending order of frequency, include increased frequency of urination (during the day initially but at night later in the disease course), dysuria, frank pain, suprapubic pain, blood or pus in the urine, and fever[emedicine.medscape.com]
Gagging
  • Hyperuricosuria and hypercalciuria were observed in group II and group III patients, along with increased excretion of oxalate and creatinine, accompanied by decreased excretion of inhibitors such as citrate and glycosaminoglycans (GAGs).[ncbi.nlm.nih.gov]
Left Flank Pain
  • A 45-year-old male presented with history of left flank pain for 1 year, which was mild dull aching in nature.[html.rhhz.net]
Delusion
  • The cries of "collusion with delusion," principally from psychoanalysts, have quieted. The dire predictions of psychosis and/or suicide following surgery as the "last psychic defenses are cut away" have almost never been realized.[books.google.com]
Hematuria
  • The laboratory findings included hematuria (27.3%), pyuria (12.1%), and hematuria with pyuria (48.5%).[ncbi.nlm.nih.gov]
  • 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 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]
  • 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]
Dysuria
  • 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]
  • 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]
  • 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]
Epididymal Swelling
  • FNAC was performed in 2 cases with epididymal swelling and was suggestive of TB in both cases pus from 3 pyonephrotic kidneys revealed AFB in 1 case.[urologyannals.com]
  • Tender testicular or epididymal swelling, beading of the spermatic cord, and epididymocutaneous sinus formations may develop. In the early phases, TB epididymitis is indistinguishable from bacterial epididymo-orchitis.[emedicine.medscape.com]
Urinary Incontinence
  • .  Urinary Incontinence (stress intolerance, urge incontinence, overflow incontinence or functional incontinence) Hematuria or change in color, volume of urine Nocturia and its date of onset Renal calculi (kidney stones), passage of stones or gravel[slideshare.net]
Sexual Dysfunction
  • Possible complications include loss of fertility, sexual dysfunction, urinary tract strictures, fistula formation and hypertension secondary to renal disease.[symptoma.com]

Workup

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 [6]. 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 [9] [10].

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 [3].
  • 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).
Pyuria
  • 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]
  • 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.[symptoma.com]
Hyperuricosuria
  • Hyperuricosuria and hypercalciuria were observed in group II and group III patients, along with increased excretion of oxalate and creatinine, accompanied by decreased excretion of inhibitors such as citrate and glycosaminoglycans (GAGs).[ncbi.nlm.nih.gov]
Chlamydia
  • In recent years, considerable attention has been given to the role of Myco plasma and Chlamydia in both male and female infertility and the problems related to genital herpes and human papilloma virus infections.[books.google.com]
Granulomatous Tissue
  • Hypercalcemia may occur, usually secondary to abnormal cortisol production by granulomatous tissue. [43] Although calcification is unusual in the early stages of the disease, nearly every end-stage tuberculous kidney contains calcification.[ijri.org]

Treatment

  • 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]

Prognosis

  • 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]
  • The ultimate prognosis is determined by the degree of systemic illness.[emedicine.medscape.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]
  • Tubal surgery has a poor prognosis.[glowm.com]

Etiology

  • […] 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: [4] [5] Etiology[amboss.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]
  • 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 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]

Epidemiology

  • 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]
  • 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]
  • Epidemiology It usually strikes young adults with tuberculosis in other places of the body as well.[ipfs.io]
  • Tuberculosis - diagnosis Tuberculosis - management Epidemiology 2013 ERS[erj.ersjournals.com]
Sex distribution
Age distribution

Pathophysiology

  • 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: [7] [8] [9] 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]

Prevention

  • Author information 1 Radiology Unit, Department of Diagnostic Medicine and Prevention, St.[ncbi.nlm.nih.gov]

References

Article

  1. Goel A, Seth A, Kumar R. Autocystectomy following extensive genitourinary tuberculosis: Presentation and management. Int Urol Nephrol. 2002;34(3):325–327.
  2. Nzerue C, Drayton J, Oster R, Hewan-Lowe K. Genitourinary tuberculosis in patients with HIV infection: Clinical features in an inner-city hospital population. Am J Med Sci. 2000;320(5):299–303.
  3. Wise GJ. Urinary tuberculosis: Modern issues. Curr Urol Rep. 2009;10(4):313–318.
  4. Wise GJ, Shteynshlyuger A. An update on lower urinary tract tuberculosis. Curr Urol Rep. 2008;9(4):305–313.
  5. Muttarak M, ChiangMai WN, Lojanapiwat B. Tuberculosis of the genitourinary tract: Imaging features with pathological correlation. Singapore Med J. 2005;46(10):568–574.
  6. Engin G, Acunaş B, Acunaş G, Tunaci M. Imaging of extrapulmonary tuberculosis. Radiographics. 2000;20(2):471–488.
  7. Miyake H, Fujisawa M. Tuberculosis in urogenital organs. Nihon Rinsho. 2011;69(8):1417-1421.
  8. Figueiredo AA, Lucon AM. Urogenital tuberculosis: Update and review of 8961 cases from the world literature. Rev Urol. 2008;10(3):207–217.
  9. Moussa OM, Eraky I, El-Far MA, Osman HG, Ghoneim MA. Rapid diagnosis of genitourinary tuberculosis by polymerase chain reaction and non-radioactive DNA hybridization. J Urol. 2000;164(2): 584-588.
  10. Hemal AK, Gupta NP, Rajeev TP, Kumar R, Dar L, Seth P. Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology. 2000;56(4): 570-574.

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Last updated: 2019-07-11 20:41