Incidental Tuberculosis Epididymitis/Epididymo-orchitis: A Retrospective Analysis at a Tertiary Center in Taiwan.

OBJECTIVES: To determine the earliest noticeable manifestation and diagnosis in patients diagnosed with tuberculosis (TB) epididymitis/epididymo-orchitis incidentally and to analyze their responses to surgical and medical treatment. METHODS: Patients who underwent surgery for the preliminary impression of chronic epididymitis/epididymo-orchitis or epididymal/testicular tumor from 2000 to 2019 were included in the study. The clinical presentations, laboratory data, radiological examinations, and operative findings were analyzed retrospectively. The outcomes were assessed by the responses to anti-TB chemotherapy and post treatment radiographic evaluations. RESULTS: All of our 25 patients with a mean age of 60.6 years were diagnosed incidentally with TB epididymitis (48.0%) and TB epididymo-orchitis (52.0%) according to the histopathological findings from their surgeries. The presence of a palpable scrotal mass (76.0%), was the major presentation. Nineteen (76.0%) patients had undergone complete chemotherapy after the surgery and 15 (78.9%) patients showed complete recovery. Four (21.1%) patients had unfavorable outcomes, 3 had TB autonephrectomies and 1 required re-surgery years after complete chemotherapy. Of the 3 (12.0%) patients who did not receive chemotherapy after their surgeries, 1 had a TB relapse in the spine and lung and 1 developed bladder cancer years later. CONCLUSION: Tuberculosis epididymitis/epididymo-orchitis is difficult to diagnose. However, some clinical clues can assist including aged patients, extragenital TB histories, poor responses to antibiotic treatment and scrotal skin lesion. Complete anti-TB chemotherapy is mandatory even after the total removal of TB lesion. Supplemental surgical interventions can be considered when the symptoms are not relieved after chemotherapy. Lifespan follow-up is recommended due to high relapse rate.

[Masks of urogenital tuberculosis as the cause of diagnostic errors].

Urogenital tuberculosis does not have pathognomonic symptoms, so diagnostic errors are quite common. This systematic review of literature was conducted to identify the causes and estimate the incidence of erroneous diagnoses. We critically evaluated some articles in which the authors describe observations of urogenital tuberculosis as rare and unusual because they never encountered this disease, but in fact that were typical manifestations of genitourinary tuberculosis. The authors analyzed and illustrated the features of urinary tuberculosis in patients with pulmonary tuberculosis, differential diagnosis of urogenital tuberculosis and kidney cancer and male genitourinary organs, described errors in the diagnosis of urethral, testicular, penile, prostatic and epididymal tuberculosis. Urolithiasis was described as a mask and concomitant disease of urogenital tuberculosis. Really rare forms of bladder tuberculosis as the cause of diagnostic errors are described. Examples of fatal outcomes of urogenital tuberculosis are given. The authors analyzed cases of granulomatous interstitial nephritis due to tuberculosis infection and tuberculosis of the renal artery as the cause of renovascular hypertension. The most common causes of late diagnosis of urogenital tuberculosis are the absence of a typical pattern and the tendency to manifest under the guise of other diseases.

[The role of pathogenetic therapy in preserving ejaculate fertility in patients with tuberculosis of prostate].

INTRODUCTION: Genital tuberculosis impairs male reproductive function. Given that tuberculosis of the prostate has been found at autopsy in 77% of men who died of tuberculosis of all locations, the problem is highly relevant. AIM: To develop and test a method of restoring/preserving fertility in patients with prostatic tuberculosis and to evaluate its effectiveness. MATERIAL AND METHODS: TThis is an open, prospective, comparative, randomized study, comprising 72 patients with prostatic tuberculosis. Patients of the main group (n=49) received standard TB treatment in combination with pathogenetic spermatoprotective therapy including zinc and selenium based dietary supplement and chorionic gonadotropin. The men in the comparison group (n=23) were treated only with etiotropic TB therapy. RESULTS: TB treatment had a negative effect on the ejaculate: in the comparison group a two-month course of drug therapy resulted in a decrease in sperm cell count by 23.9%, in the number of actively motile sperm cells by 10.6% and in the number of normal sperm cells by 32.3%. Pathogenetic spermatoprotective therapy increased the sperm cell count by 47.8%, the number of active mobile forms of spermatozoa (total of A and B) by 40.5%, the number of normal sperm cells by 41.9%. CONCLUSIONS: Spermatoprotective therapy, including human chorionic gonadotropin and zinc and selenium based dietary supplement significantly increases the ejaculate fertility.

Tuberculosis genitourinaria en paciente con sida / Genitourinary tuberculosis in an AIDS patient

Introducción: la tuberculosis es una enfermedad con una alta prevalencia en los países en vías de desarrollo. Entre los casos de tuberculosis extrapulmonar, la tuberculosis genitourinaria es común y esta situación se acentúa en los pacientes con sida. Objetivo: describir las características clínicas de un paciente que presentó tuberculosis genitourinaria detectada mediante el empleo de la reacción en cadena de la polimerasa. Presentación del caso: paciente masculino de 34 años de edad, seropositivo al virus de la inmunodeficiencia humana desde 2004, con antecedentes de tuberculosis pulmonar, que ingresa en junio de 2014 en el Hospital del Instituto de Medicina Tropical Pedro Kourí refiriendo fiebre de alrededor de dos meses de duración, intermitente, vespertina, acompañada de sudoraciones profusas y pérdida de peso importante. Además, se constata la presencia de disuria desde el comienzo de la fiebre. Recibió varios tratamientos con antibióticos sin respuesta. Se detecta Mycobacterium tuberculosis en la orina del paciente mediante la reacción en cadena de la polimerasa. Tres meses después, es reevaluado y se encuentra afebril, con aumento de peso, evolución clínica favorable y continúa con la primera fase de tratamiento anti-tuberculosis. Conclusiones: el evento ocurrido en este caso sugiere que los facultativos deben pensar en el diagnóstico de la tuberculosis genitourinaria en los pacientes con sida(AU)

Introduction: tuberculosis is highly prevalent in developing countries. Genitourinary tuberculosis is a common type of extrapulmonary tuberculosis, particularly in AIDS patients. Objective: describe the clinical characteristics of a patient with genitourinary tuberculosis detected by polymerase chain reaction. Case presentation: amale 34 year-old patient seropositive for human immunodeficiency virus since the year 2004 and a history of pulmonary tuberculosis is admitted in 2014 to the hospital at Pedro Kouri Tropical Medicine Institute. The patient had had intermittent vespertine fever for about two months as well as profuse sweating and considerable weight loss. Dysuria had also been present since the onset of fever. The patient had received several antibiotic treatments with no response. Mycobacterium tuberculosis was detected in the patient's urine by polymerase chain reaction. Re-evaluation performed three months later found that the patient was afebrile, had gained weight and his clinical evolution was favorable. The patient continues at the first stage of tuberculosis treatment. Conclusions: the event described suggests that physicians should consider genitourinary tuberculosis in their evaluation of AIDS patients(AU)

Male genitourinary tuberculosis--13 years experience at a tertiary care center in India.

We conducted a retrospective study of genitourinary tuberculosis (TB) among males attending a hospital in the northern Himalayan region of India. Records from 1 January 1997 to 31 December 2009 were reviewed for clinical history, relevant radiological findings laboratory data, histopathology and treatment. Of the 1,113 male urogenital non-neoplastic specimens received at the histopathology laboratory of the hospital, tuberculosis was diagnosed in 25 cases (2.2%). Urinary bladder and prostate were the most common organs involved. Thirty-six percent of cases had a previous history of TB; 12% of cases presented with no symptoms. Ziehl-Neelsen staining was positive in 72% of cases. Cultures were positive for TB in 42.8% of cases and polymerase chain reaction was positive in two cases in which it was performed. Antituberculosis treatment was required for up to 12 months in some cases and surgery was required in 32% of cases. Genitourinary TB in this study had varying presentations. Cases having strong clinical and radiological findings and suggestive histopathology for tuberculosis, even without demonstration of mycobacteria may be considered for TB treatment, particularly in endemic areas. Patients living in more remote areas may have more specific and severe symptoms due to late presentation. Histopathology plays a crucial role in diagnosis due to lack of sophisticated techniques. The emphasis should be on early detection followed by prompt treatment to avoid further complications.

[Particular features of detection of patients with urogenital tuberculosis and their management].

The rate and trend in extrapulmonary tuberculosis (TB) incidence including urogenital tuberculosis (UTB) were estimated in population of the Sverdlovsk region for the last 25 years. Long-term results of treatment of 591 patients with different forms of UTB (renal parenchyma TB, tuberculosis papillitis, monocavernous and polycavernous renal TB, male genital TB) were studied. Ureter was involved in tuberculosis process in 24.7% of UTB cases, urinary bladder--in 20.1%, renal TB combined with male genital TB. Early (non-destructive) forms incidence increased 2.8-fold while advanced forms incidence decreased 1.7-fold. This shows an increased level of detection. Total number of patients operated in state hospitals with undetected, mostly complicated urogenital male tuberculosis remains high--from 7.3 to 16% from all newly detected patients.

Disseminated kidney tuberculosis complicating autosomal dominant polycystic kidney disease: a case report.

Mycobacterium tuberculosis infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is rare, and its diagnosis and treatment are difficult because numerous cysts are exposed to infection and antibiotics do not easily penetrate infected cysts. Here, we report the case of a 43-year-old Japanese man with disseminated urogenital tuberculosis (TB) and ADPKD without human immunodeficiency virus (HIV) infection. Delayed diagnosis and ineffective anti-TB chemotherapy worsened his condition. Finally, he underwent bilateral nephrectomy but experienced postoperative complications. In conclusion, kidney TB should be recognized as a cause of renal infection in ADPKD, and surgical treatment should be instituted without delay. The importance of early diagnosis and treatment cannot be overemphasized to prevent kidney TB deterioration.

[A case of tuberculous epididymitis after Bacillus Calmette-Guérin intravesical instillation therapy for bladder cancer].

A 65-year-old male had undergone transurethral resection of bladder tumor (TUR-Bt) four times for recurrent bladder cancer, and each histopathological examination revealed non-invasive urothelial carcinoma, pTa, G2. To prevent further recurrence, he received eight weekly intravesical instillations of Bacillus Calmette-Guérin (BCG). Four months after the BCG therapy, he underwent cystoscopy. One week after the cystoscopy, he developed a painful and swollen left scrotum. Treatment with levofloxacin for acute epididymitis reduced the scrotal pain initially, but the pain increased and 3 months later, a fistula with suppurative discharge appeared at the bottom of the scrotum. A smear of the discharge revealed Gaffky 2, and a culture showed tubercle bacillus. Incisional drainage of the abscess and anti-tuberculosis chemotherapy for 2 months to treat tuberculous epididymitis was not completely effective. We performed a left orchiectomy with resection of the infected scrotal skin. Histopathological examination showed tuberculous epididymitis consisting of a caseating granuloma with epithelioid cells and Langhans giant cells. He received anti-tuberculosis chemotherapy for 4 months postoperatively and had no sign of recurrence 1 year postoperatively.

Orquitis tuberculosa aislada / Isolated tuberculous orchitis

Presentación de un caso poco frecuente de tuberculosis genital aislada, en un hombre de 28 años, no fumador, sin antecedentes clínicos significativos...

Tuberculous epididymitis presenting as huge scrotal tumor.

Genitourinary tract tuberculosis is a specific chronic granulomatous infection. However, epididymal tuberculosis presented as a huge scrotal mass is uncommon. We report one case of epididymal tuberculosis that was noted 5 months after the prostate biopsy and was managed with unilateral simple epidymo-orchiectomy. Antituberculous drugs have been given as the medical treatment of tuberculosis postoperatively. Urinalysis became normalized and the scrotal ultrasonography showed normal left epididymis and testicle at 6-month follow up.

[Case of tuberculous epididymitis caused by intravesical BCG therapy].

Intravesical Bacillus Calmette-Guerin (BCG) therapy is commonly used against superficial urothelial carcinoma, especially carcinoma in situ (CIS). We report a case of tuberculous epididymitis that occurred during a course of intravesical BCG therapy. A 76-year-old man had received intravesical BCG therapy for multiple superficial bladder cancer and CIS in prostatic urethra after transurethral resection of bladder tumor (TUR-Bt). He recognized hard nodules in the left scrotum after 4 times intravesical BCG therapy. Skin fistula in scrotum occurred 5 months later. We performed left orchiectomy with scrotum skin resection. Histological diagnosis was tuberculous epididymitis. Postoperatively, he was administered chemotherapy consisting of isoniazid, refampin and ethambutol.

An update on lower urinary tract tuberculosis.

Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guérin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.

[Diagnosis and treatment of isolated tuberculous epididymitis].

OBJECTIVE: To improve the diagnosis and the treatment of tuberculous epididymitis. METHODS: Retrospective studies were made of 20 cases of isolated epididymal tuberculosis defined as "tuberculosis infection affecting the epididymis without evidence of renal involvement as documented by the absence of acid fast bacilli in the urine sample and on imaging" among 35 patients with epididymal tuberculosis. Two weeks after the intensified anti-TB treatment by the combined therapy of Isoniazid + Rifampicin + Streptomycin or Ethambutol, all the patients underwent surgical removal of the tuberculous lesion, followed again by the combined therapy for 6-9 months. RESULTS: Of the 20 cases, 16 experienced no recurrence and complications within 0.5-5 years after the surgery, 3 were found with urinary tuberculosis at 3, 3.5 and 5 years, and 1 developed tuberculous epididymitis of the other side at 3.5 years. CONCLUSION: Isolated tuberculous epididymitis may be the sole or the initial presentation of genitourinary tuberculosis, for which timely surgery is the best option and has a good prognosis.

Probable tuberculosis en lesión ulcerada en pene / probable tuberculosis in ulcer in penis

Presentamos el caso de un varón de 52 años de edad que presentaba una lesión ulcerativa en el glande, de 20 años de evolución, habiendo recibido diferentes tipos de tratamiento sin éxito. La lesión presentaba bordes irregulares, consistencia dura y no había dolor. El estudio histopatológico mostró granuloma necrótico, BAAR positivo, sugestivo de TBC.

[Male genital tuberculosis in West Siberia]. / Tuberkulez polovykh organov u muzhchin v Zapadnoi Sibiri.

Clinical picture and structure of male genital tuberculosis were analyzed basing on case histories of Novosibirsk regional tuberculous hospital (outpatient department): 42 patients with tuberculous epidydymitis and 58 patients with prostatic tuberculosis. Efficiency of combined etiopathogenetic treatment was estimated in 91 patients admitted to the Urogenital clinic of Novosibirsk Research Institute of Tuberculosis. These patients received polychemotherapy alone (control group) or in combination with laser therapy (study group). Combination of polychemotherapy with laser radiation proved more effective than polychemotherapy alone.

[Diagnosis and treatment of tuberculosis in the male genital system].

OBJECTIVE: To probe into and improve the diagnosis and treatment of tuberculosis (TB) in the male genital system. METHODS: Fifteen patients with the male genital system TB established by microbiological and pathological examinations were retrospectively reviewed. RESULTS: The male genital system TB was diagnosed by history, physical examination, semen analysis, TB culture and biopsy. Treatment consisted of antituberculous chemotherapy for all the patients before and/or after operation, including 5 cases of epididymectomy and 6 cases of orchi-epididymectomy. CONCLUSION: The male genital system TB tends to be atypical and semen polymerase chain reaction of TB (TB-PCR) may provide a new specific means for diagnosis in case of clinical suspicion. Surgical approaches should be cautiously adopted, especially for young patients.