ABSTRACT
@#Genitourinary tuberculosis (GUTB) represents a critical aspect of extra‑pulmonary tuberculosis (TB). While it is the second most common form of this disease, its diverse clinical presentations pose a substantial challenge. This report, titled “Varied Clinical Presentations of Genitourinary Tuberculosis: A Case Series from a Tertiary Philippine Hospital,” aims to shed light on the intricacies of GUTB diagnosis, treatment, and its broader implications. In this case series, we present five unique clinical scenarios. Cases 1, 2, and 3, having completed TB treatment, developed spontaneous genitourinary fistulae. Case 4 was initially managed as interstitial cystitis, while Case 5 underwent diverticulectomy for a urethral diverticulum. The diagnosis of GUTB as the underlying cause in these cases, despite conventional treatment, highlights the diagnostic challenges posed by this disease. All five patients, experienced irritative voiding symptoms and recurrent urinary tract infections with limited improvement following antibiotic therapy. Imaging studies consistently revealed upper urinary tract involvement. Importantly, only one case exhibited histologic evidence of granuloma suggestive of GUTB, and microbiologic confirmation of Mycobacterium tuberculosis infection was obtained in only two cases. This underscores the need for a multidimensional diagnostic approach. The findings in this case series emphasize that GUTB diagnosis, often reliant on clinical findings supported by imaging studies and suggestive cystoscopy findings, remains critical for prognosis, even in the absence of microbiologic confirmation. Beyond the individual cases, this series offers insights into the complexity of GUTB, raising questions about the overall management and implications for TB control.
Subject(s)
TuberculosisABSTRACT
Background@#This retrospective cohort study assessed the outcomes of combined surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) in 31 patients with a follow-up of 7 years.@*Objectives@#The study aimed to determine the success and recurrence rates of POP and SUI while comparing the outcomes, analyzing the predictors for recurrence, and reporting on complications.@*Materials and Methods@#Demographic and clinical profiles were analyzed descriptively using frequency and percentages. Objective SUI cure rate was assessed via office cystometry with a cough stress test, while POP was evaluated using the POP-Q system. Subjective cure rates for both conditions were determined using a symptom severity checklist based on the King's Health Questionnaire. Chi-square tests assessed associations between objective outcome parameters and time elapsed since surgery, and other outcome predictors, with significance set at p < 0.05.@*Results@#The results showed a high objective cure rate of 96% for SUI and subjective cure rates of 96% for both SUI and POP. Long-term symptoms included urine frequency and retention, while mesh erosion occurred in one patient. The objective cure rate for POP was 67.7%, with recurrence in the anterior compartment at the midterm and in various compartments at long term. Vault fixation suggests efficacy in reducing apical prolapse recurrence. The preoperative age was identified as a significant risk factor for POP recurrence. @*Conclusion@#This study supports the durability and efficacy of combined surgeries for SUI and POP, with high patient satisfaction.
Subject(s)
Suburethral SlingsABSTRACT
@#Fetal Pleural Effusion is a rare case whose management is still a matter of debate. Its course may spontaneously resolve or lead to pulmonary hypoplasia and result in death in utero or poor neonatal outcome. This paper is a report of 2 cases and their course, from prenatal diagnosis of Pleural Effusion to delivery. This report includes sonographic scans, description of the laboratory work – up and other imaging tests that were done. The 1st case report was successfully managed with Thoraco-amniotic shunting, while the 2nd case was seen late and had an adverse neonatal outcome. This case report was done to increase awareness among obstetricians and sonologists in offering counsel to patients and their families, especially in our low resource set-up, where in in utero interventions are not available.