Genitourinary tuberculosis: Clinical features in a general hospital population

Abstract

Seventy-eight patients with genitourinary tuberculosis were evaluated during a 12 year period. Active tuberculosis was confined to the genitourinary tract in all but 10 patients. Aside from five cases of miliary tuberculosis, most genitourinary infections developed from the breakdown of granulomes acquired earlier during transient dissemination from a primary pulmonary infection. Patients with genitourinary tuberculosis exhibited features of local organ dysfunction rather than systemic symptoms of infection; fever, weight loss and anorexia were uncommon. Seventy-one per cent of the patients with active tuberculosis of kidneys, ureters and bladder presented because of urinary tract symptoms. Twenty per cent were asymptomatic and were detected because of abnormal urinary sediments. The diagnosis of genitourinary tuberculosis should be suspected on the basis of an abnormal urinalysis (hematuria and/or pyuria) with negative routine cultures, and a positive tuberculin skin test. Intravenous pyelograms disclosed abnormalities in most patients but were rarely diagnostic. Serial intravenous pyelograms disclosed increasing ureteral obstruction during chemotherapy in three patients. Multiple drug chemotherapy is the mainstay of treatment, but reconstructive surgery remains important. Male genital tuberculosis may result from direct spread from infected urine or from hematogenous seeding. Our nine patients presented with a mass lesion in the epididymis, testicle or prostate. Female genital tuberculosis results from hematogenous seeding, with fallopian tube involvement most common. Infertility, pelvic pain or abnormal vaginal bleeding were the initial symptoms. Endometrial curettage is important for the diagnosis of tuberculosis endometritis, and tuberculosis salpingitis often requires laparotomy for diagnosis.