Enhancing Efficacy and Safety in Laparoscopic Partial Nephrectomy for Localized Renal Tuberculosis: The Skirted Continuous Suture Technique.

BACKGROUND Limited research has been conducted on laparoscopic partial nephrectomy for kidney tuberculosis. This study aimed to evaluate the effectiveness of the skirted continuous suture technique in laparoscopic partial nephrectomy for localized renal tuberculosis. MATERIAL AND METHODS Five patients with kidney tuberculosis underwent standard retroperitoneal laparoscopic partial nephrectomy after computed tomography evaluation. The skirted continuous suture technique was utilized during the procedure. This retrospective study analyzed the outcomes of these patients who received treatment between January 2011 and December 2020 at Beijing Tsinghua Changgung Hospital and Eighth Medical Center of Chinese People's Liberation Army General Hospital. RESULTS The surgical success rate was 100%. Renal function was well preserved, with a decrease of glomerular filtration rate by 9.6±9.0 ml/min. Only 1 patient experienced postoperative urinous infiltration and lymphatic fistula, while the others did not have any surgical complications. Antituberculous therapy was continued postoperatively, and 1 patient had recurrence during follow-up. CONCLUSIONS The laparoscopic continuous suturing technique offers a reliable and straightforward method for extensively closing incision edges of the renal parenchyma in laparoscopic surgery. It contributes to the improved efficacy and safety of treating localized renal tuberculosis with exceptional application.

[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.

Comparison of the CapitalBio™Mycobacterium RT-PCR detection test and Xpert MTB/RIF assay for diagnosis of renal tuberculosis.

The purpose of this study is to compare the efficiency difference between CapitalBio™Mycobacterium real-time polymerase chain reaction (RT-PCR) detection test and Xpert MTB/RIF assay for the diagnosis of renal tuberculosis (TB). We analyzed 117 samples collected between July 1, 2018, and October 31, 2019, from patients with suspected renal TB to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of the CapitalBio™ Mycobacterium RT-PCR detection test for renal TB and to evaluate its diagnostic accuracy compared with Xpert MTB/RIF assay. Five cases were excluded from this study because of incomplete data. Taking clinical diagnosis as the gold standard, for the Xpert MTB/RIF assay, the sensitivity was 87.95% (78.96-94.07%), specificity 96.55% (82.24-99.91%), PPV 98.65% (92.70-99.97%), NPV 73.68% (56.90-86.60%), and AUC 0.92 (0.86-0.96). For the CapitalBio™Mycobacterium RT-PCR detection test, the overall sensitivity was 84.34% (74.71-91.39%), specificity 93.10% (77.23-99.15%), PPV 97.22% (90.32-99.66%), NPV 67.50% (50.87-81.43%), and AUC 0.89(0.81-0.94). The diagnostic efficiency of the CapitalBio™Mycobacterium RT-PCR detection test was similar to that of the Xpert MTB/RIF assay in patients with renal TB. Hence, the CapitalBio™Mycobacterium RT-PCR detection test presents a valuable alternative for the diagnosis of renal TB.

[Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis].

INTRODUCTION: Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. CLINICAL CASE: A clinical observation of patient Ch., born in 1976, who was admitted to TB Research Institute of Ministry of Health of Russia on 17.02.2020. A diagnosis was cavernous renal tuberculosis. Tuberculosis of the ureter. MBT (-). Right ureteral stricture (obliteration), complicated by ipsilateral hydronephrosis. Right nephrostomy tube (2018). Clinical cure of disseminated pulmonary tuberculosis. He underwent planned laparoscopic bowel substitution of the right ureter on 10.03.2020. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. CONCLUSION: 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.

[Surgical treatment of patients with renal tuberculosis, complicated by ureteral tuberculosis].

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.

Application of whole-genome sequencing in a case study of renal tuberculosis in a child.

BACKGROUND: Urogenital tuberculosis (TB) is rare in children and usually develops due to reactivation of the foci in the genitourinary tract after the latency period following initial infection. Urogenital TB in children has no pathognomonic clinical features that can result in overlooking or misdiagnosing this clinical entity. Here, we report important findings regarding the pathogenesis and transmission of TB by using genotyping and whole-genome sequencing (WGS) in a study of renal TB case in a child. CASE PRESENTATION: A 13-year-old boy was admitted to the hospital because of high fever, severe dry cough, flank pain and painful urination. Abdominal ultrasonography and CT revealed an 8 mm calculus in the kidney, and clinical findings were initially interpreted as nephrolithiasis. Nevertheless, due to the atypical clinical presentation of kidney stone disease, additional investigations for possible TB were performed. The QuantiFERON®-TB Gold Plus test was positive, and the Mantoux test resulted in 15 mm of induration, confirming infection with Mycobacterium tuberculosis (Mtb). Chest X-ray was normal. Chest CT revealed calcified intrathoracic lymph nodes. The urine sample tested positive for acid-fast bacilli, and Mtb cultures were obtained from urine and bronchial aspirate samples, resulting in a final diagnosis of intrathoracic lymph node and renal TB. Contact investigation revealed that the child's father was diagnosed with TB when the child was 1 year old. Genotyping and WGS analysis of Mtb isolates of the child and his father confirmed the epidemiological link and pointed to the latency of infection in the child. CONCLUSIONS: This case report confirmed the development of active TB from calcified lesions in adolescent after 12 years of exposure, demonstrated the absence of microevolutionary changes in the Mtb genome during the period of latency, and proved the importance of appropriate evaluation and management to prevent the progression of TB infection to active TB disease. The use of WGS provided the ultimate resolution for the detection of TB transmission and reactivation events.

Identifying risk factors for chronic kidney disease stage 3 in adults with acquired solitary kidney from unilateral nephrectomy: a retrospective cohort study.

BACKGROUND: We aimed to examine the risk factors for chronic kidney disease (CKD) stage 3 among adults with ASK from unilateral nephrectomy. METHODS: We retrospectively collected data from adult patients with ASK between January, 2009 and January, 2019, identified from a tertiary hospital in China. The clinical data were compared between patients who developed CKD stage 3 and those who did not develop CKD stage 3 during follow-up. RESULTS: In total, 172 patients with ASK (110 men; median 58.0 years) were enrolled, with a median follow-up duration of 5.0 years. During follow-up, 91 (52.9%) and 24 (14.0%) patients developed CKD stage 3 and end-stage renal disease, respectively. Multiple regression analyses showed that age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.039-1.115, p < 0.001), diabetes (OR 4.401, 95% CI 1.693-11.44, p = 0.002), hyperuricemia (OR 2.733, 95% CI 1.104-6.764, p = 0.03), a history of cardiovascular disease (CVD) (OR 5.583, 95% CI 1.884-18.068, p = 0.002), and ASK due to renal tuberculosis (OR 8.816, 95% CI 2.92-26.62, p < 0.001) were independent risk factors for developing CKD stage 3 among patients with ASK. CONCLUSIONS: Regular follow-up of renal function is needed among adult patients with ASK. Optimal management of diabetes, hyperuricemia, and CVD may reduce their risk of CKD stage 3, especially among those that undergo unilateral nephrectomy for renal tuberculosis.

Renal Tuberculosis: The Masquerader.

Tuberculosis (TB) remains a worldwide scourge and the most common cause of mortality from infectious disease. Around 95% of cases occur in developing country. Renal TB is a rare cases that complicates 3-4% of pulmonary TB patients and commonly overlooked in clinical practice due to its symptoms may mimic other diseases.A-39-year-old man was admitted to our institution due to flank pain. He had history of low grade fever and oligouria since 5 months prior. He had no complaint of cough, dyspnea, or night sweat. He was a non smoker and had no past medical history of tuberculosis. Previous 4 months abdominal ultrasound showed left pelvocaliectasis and ureteral dilatation with suspicion of left ureteral stenosis. Ureterolithiasis could not be excluded. No prostate enlargement or vesicolithiasis was seen. Intravenous pyelography (IVP) examination demonstrated similar finding. Initial laboratory blood examination showed anemia (10.7 g/dl), leukocytosis (14,080/ul), increased in serum creatinin (4.2 mg/dl), ureum (227 mg/dl), and calcium (6.78 mg/dl). Serology examinations were negative for HIV, HBsAg, anti HCV and blood culture had no growth. Urinary examination revealed severe leucocyturia, hematuria, and negative for bacteria, nitrite and cast. Urine culture was positive for Candida glabrata. Pulmonary X-ray suggested right pleural fibrotic. He was initially diagnosed as multiple myeloma with fungal infection. Nevertheless, additional peripheral blood smear showed neither rouleaux formation nor blast. He underwent percutaneous nephrostomy and got micafungin intravenously. Instead of improving, the patient deteriorated and transferred to intensive room. We then explored the possibility of TB infection. Further examination revealed positive for Mycobacterium tuberculosis in urinary polymerase chain reaction (PCR) test. Tracheal sputum examination was positive for acid fast bacilli staining. There was low level of serum vitamin D2 (5.8 ng/ml). He got TB treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol. Unfortunately, the patient eventually succumbed.

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non - functional kidney.

OBJECTIVE: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney. MATERIALS AND METHODS: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. RESULTS: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). CONCLUSION: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Laparoscopic nephrectomy outside gerota fascia and En bloc ligation of the renal hilum for management of inflammatory renal diseases.

OBJECTIVES: This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. MATERIALS AND METHODS: Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. RESULTS: Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. CONCLUSIONS: In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.

[Nephrotuberculosis and urolithiasis].

INTRODUCTION: Urolithiasis and nephrotuberculosis, due to the similarity of the radiographic patterns, share the same differential diagnosis list. The study aimed to analyze the incidence of co-occurrence of nephrotuberculosis and urolithiasis and to determine the impact of urolithiasis on the clinical course of renal tuberculosis. MATERIAL AND METHODS: This open cohort retrospective study comprised 843 patients with renal tuberculosis and 245 patients with urolithiasis. 1088 medical records were analyzed to identify cases with co-occurrence of these two diseases and determine the clinical presentation of renal tuberculosis, urolithiasis, and the comorbid state. Also, patients with pulmonary tuberculosis (44), urogenital tuberculosis (17), and chronic nonspecific pyelonephritis (12) were tested for serum concentration of total calcium and phosphorus. RESULTS: Of 843 patients with renal tuberculosis, 39 (4.6%), had concomitant nephrolithiasis. The combination of urolithiasis with nephrotuberculosis manifested by more severe symptoms; these patients had a more than two-fold risk of tuberculosis recurrence. Except for the incidence of renal colic and dysuria, the clinical manifestations of urolithiasis and nephrotuberculosis did not differ statistically significantly. Prolonged infectious and inflammatory process in the kidneys resulted in an increase in the excretion of oxalates, which was more pronounced in patients with nonspecific pyelonephritis (p<0.05). A three-month course of antituberculosis chemotherapy resulted in a 36.2% increase in the excretion of oxalates in patients with urotuberculosis (p<0.05). Excretion of uric acid also significantly increased after a three-month intake of antituberculosis drugs. CONCLUSION: In our study, the incidence of concomitant urolithiasis and urogenital tuberculosis was low (4.6%), but comorbidity significantly complicated the clinical course of the disease and worsened the prognosis of nephrotuberculosis. Antituberculosis polychemotherapy increases the risk for formation of urinary stones. Prevention of urolithiasis in patients with urogenital tuberculosis warrants further investigation.

Gross Hematuria Is More Common in Male and Older Patients with Renal Tuberculosis in China: A Single-Center 15-Year Clinical Experience.

OBJECTIVES: This study aimed to investigate the clinical features of renal tuberculosis and identify the age- and gender-related differences. METHODS: A total of 419 patients at the Peking University First Hospital from January 2000 to July 2015 were retrospectively reviewed. Data on demographic characteristics, clinical presentation, complications, laboratory results, radiologic imaging, surgical procedures, and pathology features were collected and compared between genders and 3 different age groups (under 40 years, 41-60, years and over 60 years). RESULTS: The most common local presentations were lower urinary tract symptoms (65.2%), flank pain (37.9%), and gross hematuria (26.3%). Constitutional symptoms were also observed in 38.9% of the patients. Gross hematuria was more common in male patients (32.2%) and older patients (45.5%). Flank pain was more common in female patients (43.6%). Patients younger than 40 years of age had lower frequencies of calcification of the urinary tract (22.2%) and kidney atrophy (4.2%) in CT. In the postoperative pathological reports, atrophy (35.9%) and fibrosis (38.5%) were found to be significantly more common in older patients. CONCLUSIONS: While gross hematuria is more prevalent in older patients and male patients, flank pain is more common in female patients. Radiological and pathological features including calcification of the urinary tract, fibrosis, and kidney atrophy are more common in older patients.

Extrapulmonary involvement in pediatric tuberculosis.

Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.

Early Diagnosis of Tuberculosis-Associated IgA Nephropathy with ESAT-6.

IgA nephropathy (IgAN) is the most common cause of primary renal diseases worldwide, and the early secreted antigenic target of 6 (ESAT-6) which was secreted by Mycobacterium tuberculosis (MTB) may be involved in the development and progression of IgAN. This study aimed to investigate the role of ESAT-6 for early diagnosis of IgAN caused by MTB infection. From 2011 to 2014, 21 patients with renal tuberculosis (RTB), 25 with IgAN, and 46 with IgAN infected with MTB (IgAN/MTB) were enrolled. Serum levels of antibodies against Mycobacterium tuberculosis antigen 85A (Ag85A) were measured by ELISA. Urine culture and phage amplified biologically assay were performed to detect MTB. HE staining was used to observe the morphological changes in kidney tissues. Immunohistochemistry was applied to detect the expression of ESAT-6. Immunofluorescence staining was conducted to detect IgA1. Positive rates of serum anti-Ag85A antibody and urine culture for MTB were higher in the RTB and IgAN/MTB groups than those in the IgAN group. The positive rates of plaques were also higher in RTB and IgAN/MTB groups than the positive rate in the IgAN group. By contrast, the positive rate of ESAT-6 was lower in the IgAN group than that in the RTB group or the IgAN/MTB group, whereas the expression levels of IgA1 were higher in the IgAN and IgAN/MTB groups, compared with the RTB group. Our findings suggest that ESAT-6 and IgA1 may be helpful for early diagnosis of IgAN caused by MTB infection.

[Chronic course of latent urogenital tuberculosis].

This is a case report of an elderly patient with urogenital tuberculosis and concurrent tuberculosis of peripheral inguinal lymph nodes. The disease manifested by a fistulous form of inguinal lymphadenitis for 10 years and spread to the kidneys and genitals, but the patient did not seek medical attention. Changes on the glans penis prompted him to consult dermatovenereologist. Due to ineffective treatment and uncovering the scar in the inguinal area the patient was send to an anti-tuberculosis institution, where he was diagnosed with tuberculosis involving the kidneys, prostate, epididymis, penis, inguinal lymph nodes. The patient had a history of a contact with the patient with respiratory tuberculosis. Treatment with antituberculosis drugs produced a positive effect.

[Experimental study of GeneXpert(®) system in the diagnosis of extra-pulmonary tuberculosis].

OBJECTIVE: To explore the application value of GeneXpert MTB/RIF for detection of extra-pulmonary tuberculosis and resistance to rifampin. METHODS: A total of 150 samples were collected, including 33 needle aspirates from lymphoid tuberculosis, 23 needle aspirates from spinal tuberculosis, 49 from tuberculous pleural effusions, 24 from cerebrospinal fluid of tuberculous cephalomeningitis, and 21 urinary sediment samples from renal tuberculosis. Smear microscopy, mycobacterium tuberculosis culture and the MTB/RIF method were used to examine these samples and their positive rates were compared. Rifampin susceptibility tests was performed for culture-positive strains using proportion method, which was compared with the result from GeneXpert MTB/RIF method. RESULTS: Of the 150 cases of extra-pulmonary tuberculosis, 17 samples were smear-positive, with a sensitivity of 11.3% (17/150); 30 were culture-positive with a sensitivity of 20.0% (30/150); and 96 were positive by MTB/RIF method with a sensitivity of 64.0% (96/150). There was a significant difference between MTB/RIF method and the culture method (χ(2)=59.61, P<0.01). The differences were also significant when the MTB/RIF method was compared with the smear method (χ(2)=88.60, P<0.01) or compared with culture plus smear methods (χ(2)=4.26, P<0.05). Separately, the differences were statistically significant between GeneXpert MTB/RIF method and other 2 methods for diagnosis of lymphoid tuberculosis (n=33, χ(2)=20.56, P<0.01 vs. culture method; χ(2)=27.13, P<0.01 vs. smear results) while no difference was found between culture and smear method (χ(2)=0.67, P>0.05), spinal tuberculosis (n=23, χ(2)=12.74, P<0.01 vs. culture method; χ(2)=14.81, P< 0.01 vs. smear method), tuberculous pleurisy (n=49, χ(2)=32.34, P<0.01 vs.culture method; χ(2)=49.69, P<0.01 vs. smear method) and renal tuberculosis (n=21, χ(2)=4.20, P<0.05 vs. culture method; χ(2) =8.40, P<0.01 vs. smear results). The sensitivity for tuberculous meningitis had no difference among these 3 methods (n=24, P>0.05). Rifampicin-resistance of the strains from the 30 culture-positive cases of extra-pulmonary tuberculosis (20.0%, 6/30) exhibited agreement with GeneXpert MTB/RIF test. CONCLUSION: The simplicity and high sensitivity of GeneXpert MTB/RIF technology make it a good diagnostic test for rapid detection of extra-pulmonary tuberculosis and resistance to rifampin.

[The Great Imitator. Case report]. / A nagy imitátor.

Authors present two patients suffering from renal tuberculosis, which caused differential diagnostic problems. The first patient was examined because of fever and left flank pain. Computed tomography revealed renal shrinkage on the left side. Retrograde pyelography demonstrated ureteric stricture and dilated calices. Urine culture showed Mycobacterium tuberculosis. Two months after initiation of the antituberculotic therapy nephrectomy was performed. The second patient was referred to the department because of fever after unsuccessful antibiotic treatment. Ultrasound examination showed a staghorn stone, dilated renal pelvis and perirenal abscess on the left side. Double J catheter insertion and percutaneous puncture of the abscess were performed. Culture of the pus aspirated proved Proteus morganii. Fever and complaints of the patient relieved after antibiotic treatment. Two months later double J catheter was changed because of persistent pyelonephritis. One week later the patient returned to the hospital with fever, which could not be reduced with intravenous antibiotics. Computed tomography showed purulent fluid in the left kidney, and nephrectomy was performed. Histology revealed renal tuberculosis. The authors summarize the diagnosis and treatment of renal tuberculosis on the basis of these two cases.

[Clinical and morphological parallels in the validation of surgical treatment of nephrotuberculosi].

AIM: To Study clinical and morphological variants of kidney tuberculosis (KTB), for grounding a tactics of surgical treatment. MATERIALS AND METHODS: There were 107 examined patients (patients with cavitary lesions of kidneys: cavernous and multi-cavernous), operated in different phases of KTB. There were 56 men (52,3%) and women - 51(47,7%). The mean age of patients was 57,6 years (23-84 years). All the patients had a complex examination, including X-ray and ultrasound investigations, computer tomography ( was performed selectively), bacteriological examinations of urine and morphological examinations of removed kidneys or their parts. RESULTS AND DISCUSSION: Surgical interventions were as follows: open surgery nephrectomy 86/107 (80,4%), open organ-sparing surgery (resections of kidneys) 21/107 ( 19,6%). Mycobacterium tuberculosis were revealed by cultural method in 68,6% of cases in patients with cavernous KTB and in 76,3% of cases in patients with multi-cavernous KTB. In appliance with pathomorphological results of presented specimens, there were revealed 3 groups, each one with its own properties of cavern wall. I group (74 specimens) - stage of active progressing KTB, II group (20 specimens) - stage of intermediate activity, III group (13 specimens) - stage of healed caverns. Performed morphological investigations allowed us grounded a rational tactics of surgical treatment. It was defined that the longer specific anti-TB therapy was carried out the less frequency of TB progression we would have. However when it presented isolated cavitary lesion (isolated cavern), the performance of adequate and long courses of chemotherapy is not worth to do. Only surgical interventions (resection of infected tissue) with the anti-TB therapy allowed to reach the satisfactory results in treatment of KTB.

Urinary tuberculosis: a cohort of 79 adult cases.

We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.