[Analysis of the prevalence of nonspecific urinary tract infection in patients with tuberculosis among residents of the Bukhara region of the republic of Uzbekistan].

AIM: To analyze the prevalence of nonspecific UTI in patients with tuberculosis and to evaluate the efficiency of therapy and prevention measures. MATERIAL AND METHODS: A total of 936 patients with tuberculosis of various localizations aged from 18 to 96 years were examined. There were 447 men (47.8%) and 489 women (52.2%). A diagnosis of nonspecific UTI was done using following criteria: the presence of characteristic symptoms, leukocyturia and bacteriuria detected by microscopic examination of the urine sediment, positive urine culture for nonspecific species, negative urine tests for Mycobacterium tuberculosis. RESULTS: The prevalence of nonspecific UTI among 936 patients with tuberculosis was 18.6% (n=174). Non-specific species were determined in all forms of tuberculosis, but most often in urogenital tuberculosis (74.1%). Proposed therapeutic and prophylactic tactics included antibacterial therapy, herbal drug Kanefron N and sanitary measures. The efficiency of treatment was 94.6%. It should be noted that patients received anti-tuberculosis therapy, and there were no adverse reactions associated with a combination of drugs. CONCLUSION: When choosing treatment tactics, it is necessary to take into account the presence of structural and functional changes in the urinary tract, which reduce treatment efficiency.

[Dynamics of the structure of renal tuberculosis over 20 years].

BACKGROUND: Tuberculosis is a serious medical and social problem that does not lose its importance, despite all the advances in pharmacology and surgery. Diagnosis of urogenital tuberculosis (UGTB), as a rule, is delayed due to low index of suspicion to tuberculosis and the absence of pathognomonic symptoms. AIM: Determining the change in the ratio of clinical forms of renal tuberculosis from 1999 to 2020. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study on the spectrum of the incidence of extrapulmonary tuberculosis (EPTB) was carried out. Among all 13852 extrapulmonary tuberculosis patients which were diagnosed from 1999 to 2020, patients with renal tuberculosis were selected, and the spectrum of their clinical forms in three periods was analyzed: 1st period 1999-2004 (1155 patients), second period 2005-2014 (2657 patients), and the third period 2015-2020 (671 patients). The clinical features of nephrotuberculosis in 88 patients was also estimated. RESULTS: Over the 20 years of the analyzed period, the number of patients with UGTB decreased by 80.6%; for the year of the COVID-19 pandemic, this figure fell by another third. In the first period, destructive complicated forms of nephrotuberculosis prevailed (922 patients - 79.8%), while the so-called "minor forms" were diagnosed in 233 patients (20.2%). In the second period, the situation was statistically significantly more favorable: the proportion of destructive and complicated forms of renal tuberculosis decreased to 43.8% (1124 patients), "small forms" were diagnosed in 1443 patients (56.2%). In the third period, destructive and complicated forms of nephrotuberculosis were diagnosed in 531 patients (77.6%), and the proportion of "small forms" in comparison with the previous period decreased by half, to 22.4%. Analysis of the clinical features of renal tuberculosis, depending on the prevalence of the destruction, showed that an asymptomatic course is possible, and pain, dysuria, intoxication and renal colic are present with different frequencies, and the clinical picture of tuberculosis of the renal parenchyma differs significantly from the clinical picture of tuberculous papillitis, cavernous nephrotuberculosis and symptoms of renal tuberculosis as whole. CONCLUSION: Currently, there is no screening on urogenital tuberculosis at all. Patients are diagnosed by referral, with a long history, after receiving multiple courses of antibacterial treatment; mainly through the pathomorphological examination of the operating material. Thus, a sharp decrease in the proportion of UGTB patients does not mean the disappearance of tuberculosis of this localization, but only states the tragic defects in timely diagnosis and low index of suspicion of medical doctors in relation to UGTB.

[Tuberculosis of the male genital organs].

INTRODUCTION: Tuberculosis of the genitourinary system is still of importance. The observed decrease in the incidence of urogenital tuberculosis is largely due to the inaccuracies of registering this disease. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study of the structure of urogenital tuberculosis in the Siberian and Far Eastern federal districts was carried out. We analyzed statistical reports from 2003 to 2015, which included data for a total of 456 patients, as well as extended questionnaires compiled specifically for this study. In addition, outpatient records of 95 patients with urogenital tuberculosis who were registered at the Novosibirsk Regional Tuberculosis Dispensary by 01/01/2022 were evaluated. RESULTS: An analysis of the structure of urogenital tuberculosis from 2003 to 2015 showed that urinary system was affected in the most of cases (n=314, 68.8%). Tuberculosis of male and female genital organs took the second place (n=101, 22.2%) patients. Generalized urogenital tuberculosis was diagnosed in 41 (9%) patients. From 2003 to 2008, the proportion of renal tuberculosis increased by 12.6%, but then a significant decrease in its proportion was found (82.2% in 2008 vs. 48.6% in 2015 [2 =12.71; =0.0004]). On the contrary, in 2003 the proportion of genital tuberculosis was 18% (n=18) compared to 29.1% (n=3) in 2015 (2 =3.46; p=0.06). In 2015, generalized forms of urogenital tuberculosis were diagnosed in 23 (22.3%) patients, which is approximately 2.5 times more than in 2003 (n=9; 9%) and 2008 (n=7; 6.6%) (2> 6.46; p<0.01). The proportion of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013. In 2003, tuberculosis of the scrotum was diagnosed in 100% of men with genital tuberculosis, while in 2013 and 2015 its proportion was 25%. In total, scrotal tuberculosis during whole follow-up was diagnosed in 26 patients, which accounted for 41.9% of all male genital tuberculosis. The combination of tuberculosis of the scrotum and prostate also varied significantly from 17.3 to 35.7%. Generalized urogenital tuberculosis was diagnosed with a minimum proportion (1.4%) in 2008, then there was an upward trend with a maximum rate in 2015 (22.3%, 2 =29.38; <0.0001). Among 95 patients with tuberculosis of the urinary and male reproductive system, who were followed by the phthisiourologist of Novosibirsk Regional Tuberculosis Dispensary, 34 (35.8%) had a diagnosis of kidney tuberculosis, 42 (44.2%) had isolated tuberculosis of the male genital organs, and the remaining 19 (20.0%) men had generalized urogenital tuberculosis. In total, HIV infection was detected in 23 (24.2%) patients with urogenital tuberculosis, and among patients with kidney tuberculosis, it was diagnosed in 7 (20.6%) cases compared to 9 (21.4%) cases in those with male sexual tuberculosis. In patients with generalized urogenital tuberculosis, HIV infection was detected almost 2 times more often, namely in 7 (36.8%) cases. CONCLUSION: Patients with urogenital tuberculosis are under follow-up of urologists for a long time with erroneous diagnoses, and only when the disease becomes irreversible and requires surgical intervention, the pathomorphological study of the surgical material will allow to make a proper diagnosis.

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study.

BACKGROUND: Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. METHODS: Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96). RESULTS: There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. CONCLUSIONS: The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

[Surgical treatment of patients with urogenital tuberculosis].

Despite the modest positive trends in the epidemic situation for tuberculosis, the incidence of extrapulmonary tuberculosis is not consistent. The relevance of urogenital tuberculosis remains high, as well as its social significance. Tuberculosis of the kidneys and urinary tract is often diagnosed late, when drug therapy is not enough and surgical treatment is required. A total of 78 national and foreign publications dedicated to surgical treatment of patients with urogenital tuberculosis were analyzed. Various surgical techniques for renal and bladder tuberculosis are described with a comparison of their advantages and disadvantages. Tuberculosis of the urinary system, like any infectious disease, can and must be cured with drug therapy. Unfortunately, there are complicating subjective (low alertness of doctors regarding tuberculosis, low adherence to national and international guidelines) and objective (absence of pathognomonic symptoms of urogenital tuberculosis, which results in late diagnosis, increased drug resistance of the pathogen, high comorbidity) factors. The advancements in surgical techniques and modern drugs for neoadjuvant therapy give patients the opportunity to receive minimally invasive treatment that saves not only life, but also provides them acceptable quality of life.

Urinary tuberculosis: still a challenge.

BACKGROUND: Urinary tuberculosis (TB) is a challenging disease to cope with, as there has been no noticeable difference in basic diagnostic and therapeutic options in clinical practice over time. PURPOSE: The aim of the current review was the critical assessment and evaluation of TB, which remains a major global health problem. METHODS: The available literature regarding TB in the PubMed database was extensively searched. RESULTS: New interdisciplinary team approaches such as next-generation sequencing are promising for the diagnosis and treatment of the disease. The epidemiology of the disease is changing with globalization and increasing migration events; however, the knowledge here is limited. Despite ongoing destruction, kidney functions need to be preserved as much as possible, and relatively rapid development of minimally invasive techniques relieved the surgeons in this regard. Experience is increasing in minimally invasive techniques that provide better comfort for patients compared to extensive radical surgeries. CONCLUSIONS: Knowing the pathogenesis of urinary TB is essential for understanding the range of clinical manifestations. The onset of the disease is usually insidious. Despite modern TB drugs, reconstructive surgery, and minimally invasive procedures, progression cannot be prevented in some patients, and patient selection is essential, but we still do not have sufficient information and objective parameters to predict progression.

Challenges in urogenital tuberculosis.

PURPOSE: For better understanding of urogenital tuberculosis (UGTB), its clinical spectrum and characteristic features need to be evaluated. MATERIALS AND METHODS: One hundred and forty-two cases of UGTB patients were analyzed retrospectively. We considered age, gender, symptoms, and diagnostic procedures. RESULTS: The total of 142 patients were divided into group A (consisted of 93 patients with only urinary TB), group B (consisted of 13 male patients with generalized UGTB, including urinary TB and male genital TB (MGTB). Group C consisted of 36 patients with MGTB. Sixty patients in groups A and B 56.6% had kidney TB third-to-fourth stages, which are incurable for anti-TB therapy and require surgery. The urinary tract was involved in 48 patients (45.3%): 25 (23.6%) had ureteral TB and 23 (21.7%) had also bladder TB. The most common symptom for kidney TB was flank pain (69.8%) followed by dysuria (47.2%). Perineal pain and dysuria were most common symptoms for prostate TB and were found in 87.5% (14 patients) and 56.3% (9 patients), respectively. Of total, in only 58 UGTB patients (40.8%), the culture for Mycobacterium tuberculosis (Mtb) was positive. CONCLUSION: Of 142 patients with UGTB, 106 (74.7%) had kidney TB and 13 (9.2%) of them had kidney TB in combination with MGTB. Only MGTB (prostate, scrotal, or generalized) was diagnosed in 49 (34.5%) patients. The most common symptoms were flank pain and dysuria. Identification of Mtb in UGTB is difficult. Therefore, the most advanced microbiological technology should be used to establish the correct diagnosis.

[The features of the recurrence of urogenital tuberculosis].

INTRODUCTION: Tuberculosis is an infectious disease, which can result in self-cure, chronic process or relapse course. AIM: To analyze the incidence of recurrence of urogenital tuberculosis and to identify the features of patients with recurrent disease. MATERIALS AND METHODS: Specially developed questionnaires on the structure of the incidence of extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were analyzed. We also studied 140 outpatient medical records of patients with tuberculosis of the urinary tract and male reproductive system, who was followed at the Novosibirsk Regional TB Outpatient Department. The medical records of patients with recurrent disease were analyzed in detail. RESULTS: In 2019, 563 patients with isolated extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were identified, and 14.4% of them had urogenital tuberculosis. In 99 (17.6%) patients, the present state was a relapse, while urogenital tuberculosis occupied 8.1%, and all patients were HIV-negative. In the Novosibirsk Region, 127 out of 140 patients were diagnosed with urogenital tuberculosis for the first time, and in 13 (9.3%) had recurrent disease. Among patients with relapse, male predominated (61.5%). The primary focus of tuberculosis was located in the genitourinary system in 53.9% of patients, which supports the theory of reactivation of dormant foci. In addition, 38.5% of patients with primary episode of tuberculosis were smear-positive. The average relapse time after successful cure of tuberculosis was 9.1 years. Among patients with recurrent urogenital tuberculosis, mycobacteriuria was recorded in 23.1% of cases, and in one case drug resistance of the pathogen to streptomycin and isoniazid was seen. In general, the kidneys were the most susceptible to relapses and were involved in 69.2% of cases. CONCLUSIONS: Nearly 8.1-9.3% of patients with genitourinary tuberculosis had previously tuberculosis and were successfully cured. When urogenital tuberculosis recurs, the kidneys are affected in 69.2% of cases. The overwhelming majority (61.5%) of patients with recurrent genitourinary tuberculosis are men, therefore gender can be considered a predictor of recurrence. HIV infection was found in isolated cases in patients with both newly diagnosed and recurrent urogenital tuberculosis.

Chronic kidney disease with genitourinary tuberculosis: old disease but ongoing complication.

BACKGROUND: Genitourinary tuberculosis (GUTB) is a type of extrapulmonary TB that exerts a deleterious effect on renal function by promoting renal calcification and ureteric stricture. Therefore, we investigated the risk factors for chronic kidney disease (CKD) in GUTB patients after the end of treatment. METHODS: This retrospective study was conducted at a tertiary hospital in South Korea. Data from patients (>18 years of age) with GUTB were collected from January 2005 to July 2016. CKD was defined as a glomerular filtration rate <60 mL/min/1.73m2 after the end of treatment. RESULTS: In total, 56 patients with GUTB (46.4% males; mean age 52.8 ± 16.6 years) were enrolled in the study. CKD developed in 11 (19.6%) patients and end-stage renal disease in 4 (7.1%). In a univariate analysis, older age (p = 0.029), microscopic haematuria (p = 0.019), proteinuria (p = 0.029), acute renal failure (ARF) (p < 0.001) and a positive polymerase chain reaction-based test result for TB in the urine (p = 0.030) were significantly associated with decreased renal function. In a multivariate analysis, ARF (odds ratio [OR], 54.31; 95% confidence interval [CI], 1.52-1944.00; p = 0.032) and old age (OR, 54.26; 95% CI, 1.52-1932.94; p = 0.028) were independent risk factors for CKD in GUTB patients. CONCLUSIONS: ARF and old age were independent risk factors for CKD in GUTB patients. Therefore, in elderly GUTB patients with ARF at the time of diagnosis, regular follow-up of renal function should be performed even after the end of treatment.

Tuberculosis of the Urogenital Tract in Adults in a Tertiary Referral Center.

The genitourinary system is the main location of extrapulmonary tuberculosis. In Poland, it occupies the third place after tuberculosis of the pleura and lymph nodes. The aim of this study was to evaluate the prevalence and characteristics of tuberculosis in the urogenital tract in adult patients in a tertiary referral center in the years 2007-2015. The retrospective study included 87 patients, 42 women and 45 men. The average age was 62 ± 15 years. Changes in the urinary tract were diagnosed in 91% of women and 64% of men. Testicular tuberculosis was found in ten men, prostate tuberculosis in five, and in individual cases tuberculosis of the epididymis, scrotum, uterus, and the fallopian tube were found. The diagnosis was confirmed by bacteriological methods in 47% of patients, by histopathological in 41%, and by molecular methods in 23% of patients. In 84% of patients urological or gynecological interventions had to be applied. Patients were burdened with a number of urological diseases or diseases affecting other systems which hampered the diagnosis of tuberculosis. Antituberculosis treatment gave good results. Urogenital tuberculosis is a multivariate disease and a standard unified approach is impossible.

[Is there screening for urinary tuberculosis?]

INTRODUCTION: Most of the patients with genitourinary tuberculosis are detected too late. One of the reasons for this is the lack of a simple, cheap, reliable screening. The purpose of this study was to investigate the possibility of using a recombinant tuberculosis allergen (diaskintest) as a screening test to detect patients with genitourinary tuberculosis. MATERIAL AND METHODS: This is a simple prospective, open-label cohort study comprising 197 patients admitted to the Novosibirsk Research Institute of Tuberculosis for differential diagnosis in 2014-2016. Of then, 72 patients were found to have urogenital tuberculosis, while 125 patients had chronic nonspecific infections. RESULTS: The sensitivity of the Kochs subcutaneous tuberculin test and the diaskintest was 80.4% and 63.8%, respectively. The specificity of the Kochs test was 91.5%, which makes it still possible to consider it essential in the differential diagnosis of urogenital tuberculosis and nonspecific urogenital infections. A high percentage of positive diaskintest results in patients with chronic infectious and inflammatory diseases of the genitourinary system caused a low specificity of the test - 37.5%. CONCLUSION: Diaskintest can be used in screening for genitourinary tuberculosis, but its positive result indicative for diagnosis. It may be used only as a reason for in-depth phthisiourological examination using additional provocative tests, in particular, Kochs test, which showed high diagnostic performance.

[The epidemiological situation of urogenital tuberculosis in Siberia and the Far East].

INTRODUCTION: Tuberculosis remains one of the most important problems of our time. Late diagnosis of urogenital tuberculosis (UGT) results from a lack of a clinician awareness, paucity of pathognomonic symptoms and suboptimal therapy for urinary tract infections while UGT often manifests under their disguise. AIM: To determine the incidence of urogenital tuberculosis and its structure in an epidemiologically unfavorable region. MATERIAL AND METHODS: The study compared the temporal changes in the structure of UGT morbidity from 1999 to 2015 in the Siberian and Far Eastern Federal Districts and analyzed outpatient medical records of 456 UGT patients. RESULTS: The highest (46%) proportion of UGT in the structure of extrapulmonary disease was found in 2003, the lowest (22.9%) in 2014. According to outpatient medical records, the proportions of patients with stage 1, stage 2 and cavernous forms of nephrotuberculosis ranged from 21.2 to 37%, 26 to 53.5% and 21.6 to 37%, respectively. The incidence of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013, averaging to 33.9%. CONCLUSIONS: Currently, it is impossible to estimate the true prevalence of UGT, we can only speak about the detection rate. Every fourth UGT patient was under the medical supervision with a wrong diagnosis for 5 or more years. The proportion of UGT in the structure of morbidity from all forms of extrapulmonary TB reached a minimum (22.9%) in 2014 but went up again. Introducing new technologies has led to an improvement of bacteriological verification of UGT and increased prostate tuberculosis detection rate to 35.7%.

Nationwide survey of urogenital tuberculosis in Japan.

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. Clinical data was reviewed retrospectively; no time range was specified. RESULTS: Of the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9). CONCLUSIONS: Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.

Imaging findings of urinary tuberculosis on computerized tomography versus excretory urography: through 46 confirmed cases.

BACKGROUND: Imaging findings of urinary tuberculosis (TB) on excretory urography (IVP) and CT have been reported to be nonspecific although CT may provide detailed informations. We performed a retrospective study of patients with proven urinary TB to compare imaging findings on IVP and CT and to make a systemic approach to imaging analysis of urinary TB. METHODS: Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls. RESULTS: CT was most sensitive in detecting any renal parenchyma cavities (p=0.01), hydronephrois (p=0.0005), ureteral stricture (p=0.03) and walls thickening of the renal pelvis / ureter (p< 0.0001). Four imaging patterns were noted in 20 IVPs (43%) and 34 CTs (74%) with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding. CONCLUSIONS: Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB.

Urinary tuberculosis is associated with the development of urothelial carcinoma but not renal cell carcinoma: a nationwide cohort study in Taiwan.

BACKGROUND: Obstructive uropathy and chronic urinary tract infection increase the risk of urinary tract cancer. Urinary tuberculosis (UTB) can cause chronic urinary tract inflammation, lead to obstructive uropathy, and potentially contribute to the development of urinary tract cancer. However, the association between UTB and urinary tract cancer has not been studied. METHODS: This study enrolled 135 142 tuberculosis (TB) cases (male, 69%) from a nationwide health insurance research database in Taiwan and investigated the risk factors for urinary tract cancer, with emphasis on a history of UTB. The incidence of urinary tract cancer in the general population without TB was also calculated for comparison. RESULTS: The TB patients had a mean age of 57.5 ± 19.5 years. Of the 1287 UTB and 133 855 non-UTB patients, 15 (1.2%) and 396 (0.3%) developed urothelial carcinoma, respectively (P<0.001); and 2 (0.2%) and 96 (0.1%) developed renal cell carcinoma, respectively (P=0.240). Cox regression analysis revealed that age, male sex, end-stage renal disease, obstructive uropathy, arsenic intoxication, organ transplantation, and UTB (hazard ratio: 3.38 (2.01-5.69)) were independent risk factors for urothelial carcinoma. The hazard ratio of UTB was higher among female patients (5.26 (2.12-13.06)) than that among male patients (2.96 (1.57-5.60)). CONCLUSION: Urinary tuberculosis had a strong association with urothelial carcinoma, but not with renal cell carcinoma. In TB endemic areas, the urinary tract of TB patients should be scrutinised. It is also imperative that these patients be followed-up carefully in the post-treatment period, and urinalysis, ultrasonography or endoscopy should be an integral part of the follow-up.

Tuberculosis: experience in a low endemic area Australian tertiary hospital.

BACKGROUND: Abdominal tuberculosis (ATB) poses a significant diagnostic, management, and resource challenge. In Australia, an increasing number of tuberculosis (TB) cases are being reported, and we describe our experience of ATB in an Australian tertiary institution. METHODS: All diagnosed cases of tuberculosis (TB) at the Royal North Shore tertiary hospital campus of the University of Sydney are entered prospectively into a central registry. Cases of ATB encountered between September 1991 and November 2011 were identified and retrospectively reviewed. RESULTS: In all, 841 cases of TB were identified, of which 20 were abdominal (2.4 %). Median age at presentation was 34 years (range: 22-79 years), and 55 % of patients were women. None of the patients were born in Australia and 11 patients were of South Asian origin. The most common presenting symptom was abdominal pain (65 %). Diagnosis was based primarily on histology (90 % sensitivity), and the sensitivity of PCR analysis in this series was low (44 %). Eleven of the patients required laparoscopy or laparotomy. 40 % of cases involved the peritoneum, and disease was also seen in solid organs (liver, spleen, pancreas, adrenal gland) and bowel (esophagus, small bowel, colon). CONCLUSIONS: In our local experience ATB was seen exclusively in the immigrant population. The presentation of ATB varies greatly, necessitating a high index of suspicion within the context of abdominal symptoms in high-risk groups. The role of surgical involvement is indispensable for both diagnosis and management of ATB-related complications. Surgeons should remain mindful of the diagnosis in an age of increasing worldwide incidence.

Spectrum of urogenital tuberculosis.

Urogenital tuberculosis (UGTB) plays an important role because its complications may be fatal, it significantly reduces quality of life, and it is often associated with AIDS. Diagnosis of UGTB is often delayed. We analyzed 131 case histories of UGTB patients from the years 2009-2011. Gender, age, and the clinical form and main features of the disease were taken into account. The most common form was kidney tuberculosis (74.8%). Isolated kidney tuberculosis (KTB) more often occurs in women: 56.8%. Patients of middle and old age more often showed the stage of cavernous KTB; younger patients had smaller forms. Among all cases, an asymptomatic course was seen in 12.2% and, among cases of KTB, in 15.9%. Every third patient complained of flank pain and dysuria (35.2% and 39.8%, respectively); 17% presented with toxicity symptoms, 9.1% with renal colic, and 7.9% with gross hematuria. Mycobacterium tuberculosis (MTB) in urine was found in 31.8% of cases in all levels of isolated KTB. UGTB has no specific symptom; even sterile pyuria occurs only in 25%. The acute onset of tuberculous orchiepididymitis was seen in 35.7% of patients, hemospermia in 7.1%, and dysuria in 35.7%. 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. All urogenital tract infections should be suspected as UGTB in patients who are living in a region with a high incidence rate, who have had contact with tuberculosis infection, and who have a recurrence of the disease that is resistant to standard therapy.

Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis.

BACKGROUND: Extrapulmonary tuberculosis has been an AIDS-defining condition. Individual studies that highlight the association between HIV and extrapulmonary TB are available. Our objectives were to synthesis evidence on the association between extrapulmonary tuberculosis and HIV and to explore the effective preventive measures of these two diseases. METHODS: This is a meta-analysis of observational studies reporting effect estimates on how HIV is associated with extrapulmonary tuberculosis. We searched for the eligible studies in the electronic databases using search terms related to HIV and extrapulmonary tuberculosis. Where possible, we estimated the summary odds ratios using random effects meta-analysis. We stratified analysis by the type of study design. We assessed heterogeneity of effect estimates within each group of studies was assessed using I (2) test. RESULTS: Nineteen studies (7 case control studies and 12 cohort studies) were identified for the present study. The pooled analysis shows a significant association between HIV and extrapulmonary tuberculosis (summary odds ratio: 1.3; 95 % confidence interval (CI) 1.05-1.6; I (2): 0 %). In a subgroup analysis with two studies, a significant association was found between CD4+ count less than 100 and the incidence of extrapulmonary tuberculosis (summary OR: 1.31; 95 % CI 1.02-1.68; I (2): 0 %). CONCLUSIONS: Findings show evidence on the association between extrapulmonary tuberculosis and HIV, based on case control studies. Further studies to understand the mechanisms of interaction of the two pathogens are recommended.

[Urogenital tuberculosis today].

In order to analyze the structure of urogenital tuberculosis, retrospective analysis of medical records of 131 patients with newly diagnosed urogenital tuberculosis observed in the Novosibirsk Regional TB Dispensary from 2009 to 2011 was performed. The renal tuberculosis is main form in the structure is urotuberculosis, detected in 75% of patients, and widespread destructive forms of the disease were diagnosed in more than half of cases. Isolated nephrotuberculosis was more often diagnosed in women--56.8%. 15.9% of patients had asymptomatic nephrotuberculosis; one-third of patients complained of pain in the lumbar region and frequent painful urination (35.2 and 39.8%, respectively); symptoms of intoxication were present in 17% of patients, renal colic--in 9.1%, and gross hematuria--in 7.9% of patients. Mycobacteriuria in isolated nephrotuberculosis was detected in 31.8% of cases. Acute tuberculous orchiepididymitis developed in 35.7% of patients, hemospermia was observed in 7.1% of patients, dysuria was in 35.7% of patients. The pain in the perineum, frequent painful urination (both by 31.6%), hemospermia (26.3%) were main complaints in prostate tuberculosis. Mycobacteria was detected in 10.5% of cases. It was found that urogenital tuberculosis has no pathognomonic symptoms; the most alarming manifestations include long-term dysuria, hematuria, hemospermia.

Genitourinary tuberculosis in Australia and New Zealand.

Genitourinary tuberculosis is not commonly encountered in general urological practice in Australia and New Zealand. However, this infection is easily overlooked unless clinicians maintain a strong awareness of its possibility. This brief overview is directed to reflect the present state of knowledge and management in our two countries.