ABSTRACT
OBJECTIVE: To evaluate the long-term effectiveness and consequences of augmentation cystoplasty in adult patients with small capacity bladder due to genitourinary tuberculosis (GUTB). METHODS: After approval of the institutional ethical committee, we retrospectively analyzed the database of adult patients with small capacity bladder due to GUTB treated by augmentation cystoplasty from January 2010 to December 2022 at our center. The patients were followed up at 6 weeks postoperatively, then every 3 months for first year and 6 months in second year, and then annually. Patients were assessed for symptoms, renal function, blood biochemistry levels, and ultrasound KUB at each follow-up visit. RESULTS: A total of 40 patients underwent augmentation cystoplasty were included. All patients underwent augmentation cystoplasty either with ileum (n = 35) or sigmoid colon (n = 5). On long-term follow-up, there was statistically significant improvement in bladder capacity, decrease in voiding frequency (P = .00), decrease in eGFR (P = .02) and increase in serum creatinine (P = .02). Significant complications were wound infection 4 (10%), intestinal obstruction 1(2.5%), urinary tract infection 6 (15%), bladder stone 2 (5%), mucus retention 3 (7.5%), hypocalcemia with metabolic acidosis 2 (5%) and need of intermittent catheterization in 11 (27.5%) patients. CONCLUSION: Multidrug therapy with judicious reconstructive surgery is the optimal treatment modality for GUTB with cicatrization sequelae. In GUTB, augmentation cystoplasty is a safe procedure and strict long-term follow-up is needed to prevent complications.
Subject(s)
Tertiary Care Centers , Tuberculosis, Urogenital , Urinary Bladder , Humans , Tuberculosis, Urogenital/surgery , Tuberculosis, Urogenital/complications , Female , Adult , Male , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Middle Aged , Urinary Bladder/surgery , Urologic Surgical Procedures/methods , Time Factors , Ileum/surgery , Colon, Sigmoid/surgery , Young Adult , Urinary Bladder Diseases/surgery , Postoperative Complications/etiology , Postoperative Complications/epidemiologyABSTRACT
BACKGROUND: Incidence of Tuberculosis (TB) cases in India reported in 2019 is 193 per 1 lakh population [National Tuberculosis Elimination Plan (NTEP)]. In India, annual extra pulmonary TB burden is 20-25%, of which 4% of cases are of urogenital origin (Revised National TB Control Programme, 2019; World Health Organization, 2019). The Ministry of Health and Family Welfare has made a target of eliminating tuberculosis by 2025 under the NTEP by the process of identification, notification and treatment of cases. Tuberculosis being a leading cause of infertility in developing countries, employing best clinical practices and being "TB-minded" will also save the patient of enormous anxiety and uncertainity and also decrease the time gap between clinical presentation and diagnosis to optimize fertility outcome. METHODOLOGY: A prospective cohort study of cases presenting with unusual findings and ultimately being diagnosed as genital tuberculosis was conducted in the gynaecology OPD, AIIMS, New Delhi, from November 2020 to November 2021 (1 year). Patients were investigated judiciously, diagnosis made and followed up for their response to anti tuberculosis therapy (ATT). RESULTS: This data comprises of conglomerate of ten cases with unconventional exhibition of genital tuberculosis. 70% of the cases presented with pain lower abdomen not specifically related to menstrual cycle and often confused with IBD. Tubo ovarian mass (70%) mimicking as simple ovarian cyst, ovarian carcinoma or endometriosis was the most common clinical finding we came across.
Subject(s)
Infertility, Female , Tuberculosis, Female Genital , Tuberculosis, Urogenital , Tuberculosis , Humans , Female , Tuberculosis, Female Genital/drug therapy , Prospective Studies , Tuberculosis/complications , Infertility, Female/etiology , Tuberculosis, Urogenital/complicationsABSTRACT
Tuberculosis is a top 10 leading cause of death worldwide. Lungs are primarily involved organs in tuberculosis. The rest of cases are extrapulmonary tuberculosis (14% reported in 2017). Extrapulmonary tuberculosis always presents with non-specific symptoms, thus at risk of delay diagnosis and management. In genitourinary tuberculosis, kidney alone and kidney with urinary bladder or ureter is affected in more than 70% of cases. The ureter and urinary bladder infections are almost always secondary to tuberculous involvement of the kidney. Bacilli haematogenic spreading is a known transmission pathway to the kidney. In this case, we diagnosed isolated urinary bladder tuberculosis caused by direct gastrointestinal tuberculosis infiltration, a rare occurrence of extrapulmonary tuberculosis. We illustrate the multiorgan involvement in tuberculosis infection including pulmonary, gastrointestinal, peritoneal and urinary bladder.
Subject(s)
Tuberculosis, Gastrointestinal , Tuberculosis, Urogenital , Urinary Tract Infections , Humans , Urinary Bladder , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/drug therapy , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , KidneyABSTRACT
Development of tuberculosis is closely linked to poor socioeconomic condition, poor immune functioning and mental health including depression and anxiety. Elderly population becomes an important target group for the disease and deserves special attention. Unique problem with genito urinary tuberculosis (GUTB) in elderly population is the diagnosis. One of the earliest symptoms of GUTB is increased urinary frequency which a large majority in elderly population may already have, owing to their enlarged prostates or an overactive bladder/detrusor over activity mediated centrally or peripherally, which are not uncommon in this group. When left undiagnosed and thereby untreated, GUTB usually leads to irreversible tissue damage and consequences range from abscesses, small capacity urinary bladder to renal failure.
Subject(s)
Tuberculosis, Urogenital , Urinary Bladder, Overactive , Aged , Male , Humans , Urinary Bladder, Overactive/epidemiology , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/drug therapy , Mental HealthABSTRACT
BACKGROUND: Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. METHODS: This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. RESULTS: Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). CONCLUSIONS: The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement-a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
Subject(s)
Tuberculosis, Urogenital/blood , Tuberculosis, Urogenital/urine , Adolescent , Adult , Age of Onset , Aged , Aged, 80 and over , Anemia/etiology , Child , Child, Preschool , Female , Humans , Hypoalbuminemia/etiology , Hypokalemia/etiology , Infant , Infant, Newborn , Leukocytosis/etiology , Male , Middle Aged , Philippines , Retrospective Studies , Tertiary Care Centers , Thrombocytosis/etiology , Treatment Outcome , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/therapy , Young AdultABSTRACT
We describe the clinical features of a 75-year-old man who presented to our hospital with frequent urination for 3 months. Retrograde urethrography showed extended and continuous narrowing of the stricture in the anterior urethra. Cystourethroscopy showed extended narrowing of the urethral lumen without normal membrane. Urine acid-fast bacillus culture and polymerase chain reaction assays indicated a diagnosis of urethral tuberculosis. Anti-tuberculosis therapy was initiated. Urethral tuberculosis is a very rare cause of urethral stricture in developed countries that can be diagnosed by cystourethroscopy. Urethral tuberculosis should be considered in the differential diagnosis of urethral stricture.
Subject(s)
Tuberculosis, Urogenital/complications , Urethral Diseases/complications , Urethral Stricture/etiology , Aged , Humans , Male , Urethral Diseases/microbiologyABSTRACT
Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.
Subject(s)
Hydronephrosis , Tuberculosis, Renal , Tuberculosis, Urogenital , Ureter , Humans , Hydronephrosis/surgery , Male , Russia , Tuberculosis, Renal/complications , Tuberculosis, Renal/drug therapy , Tuberculosis, Renal/surgery , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/surgeryABSTRACT
A 30-year-old, multiparous widow, with postpolio residual paralysis, presented with complaints of dull aching abdominal pain for 15 days. Ultrasound showed a mixed echogenic right adnexal mass with free fluid in the pelvis and abdomen. CT abdomen and pelvis revealed partially defined peripherally enhancing collection in lower abdomen and right adnexa suggestive of tubo-ovarian abscess. There was mild ileal wall thickening and few enlarged mesenteric lymph nodes. Ascitic fluid did not show acid fast bacilli and cultures were sterile. Extensive diagnostic laboratory work was done which was inconclusive. Diagnostic laparoscopy could not be performed due to non-availability of elective operation theatre in the COVID-19 pandemic. Presumptive extrapulmonary tuberculosis was clinically and radiologically diagnosed. She was started on daily anti tuberculosis treatment. This case shows us the importance of imaging as a diagnostic tool and as an alternative for laparoscopy in COVID-19 pandemic to diagnose abdomino-pelvic tuberculosis.
Subject(s)
Abdominal Abscess , Adnexal Diseases , Antitubercular Agents/administration & dosage , COVID-19 , Tuberculosis, Urogenital , Abdominal Abscess/diagnostic imaging , Abdominal Abscess/etiology , Abdominal Pain/diagnosis , Adnexal Diseases/diagnosis , Adnexal Diseases/physiopathology , Adnexal Diseases/therapy , Adult , COVID-19/complications , COVID-19/therapy , Diagnosis, Differential , Female , Humans , Pelvis/diagnostic imaging , Postpoliomyelitis Syndrome/complications , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed/methods , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/physiopathology , Tuberculosis, Urogenital/therapy , Ultrasonography/methodsABSTRACT
We present an unusual case of isolated urethral tuberculosis. The patient had a history of urethral strictures and persistent discharge from two peno-scrotal fistulas which was confirmed on urethrogram. He was treated with antitubercular treatment and a two stage urethroplasty.
Subject(s)
Balanitis Xerotica Obliterans/complications , Cutaneous Fistula/complications , Tuberculosis, Urogenital/complications , Urethral Diseases/complications , Urinary Fistula/complications , Humans , Male , Middle AgedABSTRACT
Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression.
Subject(s)
Kidney Failure, Chronic/complications , Tuberculosis, Urogenital/diagnosis , Adult , Antitubercular Agents/therapeutic use , Humans , Immunocompromised Host , Male , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapyABSTRACT
Abstract Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression.
Subject(s)
Humans , Male , Tuberculosis, Urogenital/diagnosis , Kidney Failure, Chronic/complications , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapy , Immunocompromised Host , Antitubercular Agents/therapeutic useSubject(s)
Pyelonephritis/diagnostic imaging , Pyelonephritis/therapy , Tuberculosis, Urogenital/diagnostic imaging , Tuberculosis, Urogenital/therapy , Aged , Chills/diagnostic imaging , Chills/etiology , Chills/therapy , Cystoscopy/methods , Humans , Male , Nausea/diagnostic imaging , Nausea/etiology , Nausea/therapy , Pyelonephritis/genetics , Tuberculosis, Urogenital/complications , Vomiting/diagnostic imaging , Vomiting/etiology , Vomiting/therapySubject(s)
Tomography, X-Ray Computed/methods , Urinary Bladder Diseases/diagnostic imaging , Urinary Bladder Diseases/pathology , Urography/methods , Fibrosis , Humans , Tuberculosis, Urogenital/complications , Urinary Bladder/diagnostic imaging , Urinary Bladder/pathology , Urinary Bladder Diseases/etiologySubject(s)
Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Urogenital/diagnosis , Ureteral Diseases/microbiology , Urinary Tract Infections/microbiology , Female , Humans , Inflammation , Middle Aged , Tomography, X-Ray Computed , Tuberculosis, Urogenital/complications , Ureteral Diseases/etiology , Urinary Tract Infections/complicationsSubject(s)
Diagnostic Errors , Dysuria/etiology , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Urogenital/diagnosis , Urinary Bladder/pathology , Urine/microbiology , Antibiotics, Antitubercular/therapeutic use , Drug Therapy, Combination , Female , Hematuria/etiology , Humans , Kidney/diagnostic imaging , Liver/pathology , Middle Aged , Stomach/diagnostic imaging , Tomography, X-Ray Computed , Tuberculin Test , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapy , Ureter/diagnostic imaging , Urinary Tract Infections/microbiologySubject(s)
Cytomegalovirus Infections/complications , Gastrointestinal Hemorrhage/drug therapy , Hemostatics/therapeutic use , Ileal Diseases/complications , Ileocecal Valve/pathology , Minerals/therapeutic use , Ulcer/complications , Antitubercular Agents/therapeutic use , Antiviral Agents/therapeutic use , Cystitis/complications , Cystitis/drug therapy , Cystitis/surgery , Erythrocyte Transfusion , Fatal Outcome , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Ileal Diseases/therapy , Ileal Diseases/virology , Ileocecal Valve/virology , Male , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Postoperative Complications/virology , Sclerosing Solutions/therapeutic use , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapy , Tuberculosis, Urogenital/surgery , Ulcer/therapy , Ulcer/virology , Urinary DiversionABSTRACT
AIMS: To demonstrate an association between female genital tuberculosis (FGTB) and endometriosis. METHODS: A total of 16 women who underwent laparoscopy (12 cases) or laparotomy (4 cases) and were found to have female genital tuberculosis and endometriosis were enrolled in this retrospective study. RESULTS: The mean age and parity were 28.2 years and 0.2, respectively. Past history of tuberculosis was present in 75% of the women (pulmonary in 50%). Menstrual dysfunction (especially oligomenorrhoea and dysmenorrhoea), constitutional symptoms, infertility, abdominal pain and lump were the main complaints. Diagnosis of FGTB was made by positive acid-fast bacilli (AFB) on microscopy, culture of endometrial aspirate, positive polymerase chain reaction (PCR), histopathological finding of epitheliod granuloma or findings of TB on laparoscopy or laparotomy. Diagnosis of endometriosis was made by laparoscopy or laparotomy. Pelvic adhesions were seen in all women, whereas frozen pelvis was seen in 7 (43.7%) women. Surgery was performed, which was laparoscopic adhesiolysis in 12 (75%), drainage of endometrioma in 12 (75%), cystectomy in 8 (50%), and total abdominal hysterectomy with bilateral salpingo-oophorectomy in 4 (25%) cases. With more then one type of (surgery in many cases). DISCUSSION: Female genital tuberculosis and endometriosis may have similar manifestations and can co-exist.
Subject(s)
Endometriosis/complications , Tuberculosis, Urogenital/complications , Abdominal Pain/etiology , Adult , Dysmenorrhea/etiology , Endometriosis/diagnosis , Endometriosis/surgery , Female , Humans , Infertility, Female/etiology , Oligomenorrhea/etiology , Recurrence , Retrospective Studies , Tissue Adhesions/etiology , Tissue Adhesions/surgery , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/surgery , Young AdultABSTRACT
A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urinary tuberculosis, ureteral stricture can deteriorate and result in ureteral obstruction during anti-tuberculosis treatment. Pre-emptive administration of corticosteroids may be beneficial for preventing such stricture in patients with a pre-existing ureteral lesion.