Genito-urinary tuberculosis revisited - 13 years' experience of a single centre.

Background: Tuberculosis had been declared by the World Health Organization (WHO) as ‘public health emergency’ in 1993. Extra pulmonary tuberculosis (E.P.T.B.) comprises 20-25% total burden of the disease in which genitourinary tuberculosis (G.U.T.B.) is 4%. Timely diagnosis and treatment will prevent the sequelae of this disease. Aims: To know the varied clinical presentations, diagnostic modalities and management of G.U.T.B. Methods: During a 13-year-period, 117 retrospective cases of GUTB were admitted in the tertiary care centre. They were analyzed for clinical presentation, diagnostic modalities and management. Results: Young patients mainly in third decade of life were commonly affected with higher incidence in females. In our study, the most common presentation was irritative voiding symptoms (66.47%) followed by haematuria (47.60%). Although it can affect the entire organ in genito-urinary system but, in the present study, kidney was the most affected organ (64.9%) following ureter (27.35%), urinary bladder (17.09%), prostate (3.4%) and epididymis (5.19%). In this study, we had not encountered any case of testicular and penile tuberculosis. Among the different diagnostic modalities in this study, the diagnostic positivity rate was 41.6% for the urine AFB test, 55.4% for the urine M. tuberculosis culture test and 67.7% for PCR. Chest x-ray was positive in 25.6% (30). ESR was raised in 62.5% and Mantoux test was positive in 61.2% patients. Conclusion: A high index of suspicion and a wide range of investigations may be required to achieve a complete diagnosis of genitourinary tuberculosis. Though short course chemotherapy with four-drug-regimen for sixmonth- duration is the mainstay of treatment, surgical interventions were required in 60% of cases of this study.

Pattern of genitourinary tuberculosis in patients with pulmonary tuberculosis

Tuberculosis is an ancient disease. It is responsible for causing a major health problem in developing countries. Genitourinary tuberculosis is the second most common form of extra pulmonary tuberculosis after lymph node involvement. This study was carried out to determine the pattern of genitourinary tuberculosis in patients with active pulmonary tuberculosis. It is a cross sectional descriptive study. Carried out in the Urology Department of Jinnah Hospital and T.B outdoor of Gulab Devi Hospital, Lahore during the period Oct, 2002 to Oct, 2004. Two hundred patients with pulmonary tuberculosis, 117 males and 83 females, ranging from 17 to 80 years of age [mean 37.9 years] were included in the study. Hundred patients were freshly diagnosed cases [group-1] and the remaining hundred patients were already diagnosed cases of pulmonary tuberculosis and had received antituberculous treatment [ATT] for at least three months [group-2]. Diagnosis of pulmonary tuberculosis was based on positive sputum smear for acid fast bacilli [AFB] by Ziehl Neelsen [ZN] staining technique. Twenty four hours urine was collected from each patient. Each specimen was examined for the presence of mycobacterium tuberculosis by ZN staining and culture on Lowenstein Jensen [LJ] medium. Positive for one or both of these procedures was taken as positive for genitourinary tuberculosis. Biopsy of urogenital tract was carried out and histopathological examination was done in patients with positive bacilluria and having urinary symptoms. Genitourinary organs of 9 patients in group-1 and 18 patients in group-2 were found involved for genitourinary tuberculosis. Among 9 patients in group-1, the urinary bladder and kidney involvement were highest 3 [33.3%] followed by epididymis 2 [22.2%] and Ureter 1 [11.1%]. Among the 18 patients in group-2, urinary bladder involvement was highest 9 [50%] followed by kidney 5 [27.8%], epididymis 3 [16.7%] and testis 1 [5.5%], Genitourinary organ involvement in patients already on antituberculous treatment is more common as compared to freshly diagnosed cases. Urinary bladder involvement is highest in both groups

118 cas de tuberculose urogenitale dans le Sud Tunisien

Objectif : Etudier les caracteristiques epidemiologiques; cliniques; therapeutiques et evolutives de la tuberculose urogenitale dans la region du Sud Tunisien. Patients et methodes : Etude retrospective de 118 cas de tuberculose urogenitale issus des regions du Sud et du Centre tunisiens. Le diagnostic a ete confirme chez tous les malades par un faisceau d'elements cliniques; biologiques; radiologiques; et/ou histologiques. Resultats : Il s'agissait de 81 hommes et 37 femmes ages en moyenne de 38 ans. Les manifestations cliniques revelatrices etaient dominees par les signes irritatifs du bas appareil urinaire (57;6). Les signes generaux ont ete observes dans 25;4des cas. Le diagnostic de certitude a ete obtenu par preuve bacteriologique (49;2); biopsie vesicale positive (12;7); et analyse anatomopathologique d'une piece d'exerese operatoire (68;6). Le traitement a consiste en une chimiotherapie anti-bacillaire chez tous les patients; en association avec une chirurgie d'exerese (70;3); une chirurgie de reconstruction (18;6); et/ou des manoeuvres endoscopiques (13;6). 80des patients etaient suivis regulierement avec un recul moyen de 6 ans. L'evolution a ete favorable dans 85;3des cas. Conclusion : La tuberculose urogenitale reste une maladie d'actualite; elle represente une maladie grave du fait des risques multiples qu'elle peut engendrer; particulierement sur la fonction renale.). Les signes generaux ont ete observes dans 25;4des cas. Le diagnostic de certitude a ete obtenu par preuve bacteriologique (49;2); biopsie vesicale positive (12;7); et analyse anatomopathologique d'une piece d'exerese operatoire (68;6). Le traitement a consiste en une chimiotherapie anti-bacillaire chez tous les patients; en association avec une chirurgie d'exerese (70;3); une chirurgie de reconstruction (18;6); et/ou des manoeuvres endoscopiques (13;6). 80des patients etaient suivis regulierement avec un recul moyen de 6 ans. L'evolution a ete favorable dans 85;3engendrer; particulierement sur la fonction renale

La tuberculose genitale masculine : a propos de 22 cas

Objectif : Rapporter les particularites epidemiologiques; anatomo-cliniques; pronostiques et therapeutiques de l'atteinte genitale masculine de la tuberculose avec revue de la litterature. Patients et methodes : Il s'agit d'une etude retrospective portant sur 22 cas de lesions genitales de tuberculose confirmees. Le diagnostic a ete pose sur un faisceau d'arguments cliniques; bacteriologiques; radiologiques et histologiques. Un traitement anti-tuberculeuse a ete instauree systematiquement. La surveillance a ete clinique; biologique et radiologique. Resultats: Les motifs de consultation ont ete par ordre de frequence decroissant : l'epididymite chronique (11 cas); une fistule scrotale (6 cas); une hydrocele (6 cas); une retention d'urine (3 cas) et une sterilite (1 cas). L'examen clinique a retrouve un nodule epididymaire dans 11 cas et une hydrocele dans 10 cas. Une leucocyturie sans germe a ete retrouvee dans un cas. L'echographie scrotale realisee a mis en evidence des lesions epididymaires dans 8 cas. Le diagnostic de certitude a ete pose sur l'examen anatomopathologique des pieces operatoires (13 cas); de fragments biopsiques (8 cas); et par la decouverte du bacille de Koch dans les urines (1 cas). L'urographie intraveineuse realisee systematiquement a retrouve des lesions urinaires associees dans 5 cas. L'evolution a ete favorable dans tous les cas.Conclusion: L'atteinte tuberculeuse isolee des organes genitaux masculins est de diagnostic difficile en dehors d'un contexte endemique tuberculeux. Une etiologie tuberculeuse doit etre suspectee devant toute orchiepidydimite trainante; particulierement sur terrain debilite ou devant une notion d'hypofertilite. Le traitement medical reste efficace en cas de diagnostic precoce; alors que la chirurgie est reservee aux cas resistants ou compliques

Tuberculosis génitourinaria en Arica / Genitourinary tuberculosis in Arica

Se analiza la TBC génitourinaria en la ciudad de Arica desde 1991 al año 2002. Se encuentran 43 casos, con predominio sexo femenino, etnia Aymará. El diagnóstico fue sospechado por las molestias urinarias y hematuria. La pielografía endovenosa fue de utilidad en la sospecha. El examen directo y cultivo permitieron iniciar el tratamiento con buena tolerancia y un sólo abandono. Fueron sometidos a cirugía, el 25,6 porciento de los enfermos. Se comenta los resultados, comparándolos con estudio efectuado en el sur deChile.

Prevalence of urinary tract tuberculosis among cases of chronic urinary tract infection in a tertiary care hospital

Prevalence of urinary tract tuberculosis among patients suffering from chronic urinary tract infection reporting to a tertiary care hospital was determined. Three hundred patients with ages between 15-70 years of both sexes [male, n = 198; female, n = 102] were included. All the cases were suffering from recurrent and chronic urinary tract infection. Twenty four hours urine specimens for acid fast bacilli culture were collected and inoculated on Lowenstein Jensen [LJ] media. The antibiotic sensitivity was performed on LJ media with antibiotics using agar dilution method. H37 Rv strain of M.tuberculosis was used as control to determine the resistant ratio. The patients were given 4 first line anti tuberculosis drugs, namely Isoniazid [INH], Rifampicin [RIF], Ethambutol and Pyrazinamide. Twenty four [8%] cases revealed positive culture for M. tuberculosis. Twenty isolates were susceptible to all the 4 drugs. Two isolates were multi drug resistant M. tuberculosis. Two isolates revealed resistance to either RIF or INK All the patients responded to treatment given. Urinary tract tuberculosis should always be considered in cases of chronic urinary tract infection, particularly when they are not relived by antibiotic therapy

Genitourinary tuberculosis: the importance of early diagnosis and management. Case presentation

Genitourinary tuberculosis is the second most common form of extrathoracic tuberculosis. The most common signs are persistent sterile pyuria in up to 90 of patients, irritative voiding symptoms and painless hematuria in up to 80 of the patients. In Puerto Rico the incidence of tuberculosis is rising, being 9.2 per 100000 population in 1992. A.I.D.S. has had a steady rise since 1983. With the rise in the incidence of both diseases and with the influx immigrants from countries were tuberculosis is endemic we should expect a rise in the number of cases of genitourinary tuberculosis. Chemotherapy is the mainstay of treatment. Surgery is performed less often. Early recognition and management is important to avoid irreversible damage to the genitourinary tract. The cases of a 43 y/o man and a 30 y/o male with A.I.D.S. are discussed

Análisis del tratamiento abreviado de la TBC genitourinaria: experiencia del Hospital de Valdivia / Analysis of short treatment of genitourinary TBC

Se analizan 120 casos de tuberculosis urogenital, diagnosticados a través de una pesquisa precoz, en el Hospital de Valdivia entre febrero de 1982 y abril de 1987. Todos fueron tratados con los esquemas abreviados TA-81 A y TA-81 B del Programa Nacional de Control de la Tuberculosis. El 88,3% de los casos tuvo confirmación bacteriológica y el 11,7% histológica. En 97 pacientes se efectuó una serie de 6 muestras de orina para estudio de Koch y en 13 se requirió más de una serie; en 32,8% la positividad se obtuvo en la 4ta., 5ta. o 6ta. muestra de la serie. Sólo 21 pacientes (18,5%) necesitaron algún tipo de cirugía, 9 de ellos nefectomía. El tratamiento fue exitoso en el 88,3%, hubo 13 fracasos y recidivas y sólo una de estas últimas persistió con cultivo de Koch positivo al finalizar el retratamiento

TBC urogenital: experiencia Hospital de Valdivia año 1979-1984 / Genitourinary TBC: experience of Hospital de Valdiva 1979-1984 years

Se presenta la experiencia en el manejo de 175 pacientes con TBC urogenital, 112 hombres y 63 mujeres, con un promedio de edad de 35,6 años. El 16,5% tiene antecedentes de un episodio de TBC anterior. Como causa de consulta destaca un 60,1% de irritación vesical, seguido de hematuria y epididimitis. El 86,8% tiene demostración bacteriológica de la enfermedad y 70 de 136 se presentan con exclusión renal radiológica unilateral al momento del diagnóstico. Todos reciben tratamiento triasociado por 18 meses con buena respuesta y tolerancia. Son intervenidos 117 pacientes, destacando como la operación más frecuente la nefrectomía total. Se controlan y son dados de alta 117 enfermos. 58 abandonan tratamiento y se desconoce su evolución. No se registra mortalidad ni recidiva durante el período de observación

Estudio de tuberculosis urogenital: Servicio de Urología, Hospiral San Juan de Dios 1975-1989 / Genitourinary tuberculosis study: urologic service, Hospital San Juan de Dios 1975-1989

Se estudian 64 casos con tuberculosis urogenital tratados en el Hospital San Juan de Dios durante 1975-1989. Se excluyeron 42 casos del período por datos incompletos. Los principales síntomas de presentación fueron: urinarios (81%), hematuria (57%) y masa genital (53%). El cultivo de Koch en orina fue positivo en el 79%. Los hallazgos pielográficos más frecuentes fueron: alteración de cálices (50%) y exclusión o atrofia renal (40%). En el examen de orina se encontró piuria aséptica (87%) y hematuria macroscópica (81%). Esta presentación no discute el tratamiento

Incidencia de la tuberculosis en el sistema genitourinario: Hospital Dr. Francisco E. Moscoso Puello / Incidence of tuberculosis in the genitourinary system: Hospital Dr. Francisco E. Moscoso Puello

De 1,600 pacientes consultados, por el Departamento de Urología en el Hospital Dr. Francisco E. Moscoso Puello, en el período comprendido entre noviembre de 1983 a febrero de 1985, encontramos 17 casos con Tuberculosis Genitourinaria. El grupo de edades más afectado fue el comprendido entre 30-39 años, con un total de 5 casos (29.2%). Donde mayor incidencia de casos hubo fue en el sexo masculino, con 10 (58.8%). El método diagnóstico que más nos ayudó fue el examen de orina con 13 (76.4%)