Post-Mortem Compared with Clinical Diagnosis of Genito-Urinary Tuberculosis in Adult Males

Abstract

5424 necropsies performed on men aged 16 and over from 1935-44 were analyzed with regard to age; race; death from tuberculosis; unhealed tuberculosis in those dead from other causes; the relationship between pulmonary renal and genital tuberculosis; and comparison of the necropsy with the clinical diagnosis of genito-urinary tract tuberculosis. The incidence of genito-urinary tuberculosis was greater among the 565 nonwhites and among men under age 40. Tuberculous lesions were found in the genito-urinary organs in 3.1% of necropsies in 4.5% of persons harboring unhealed tuberculous lesions who died from other causes and in 26% of those who died from tuberculosis. 85% of men with tuberculous lesions in the genito-urinary system had caseous or cavitating pulmonary foci. 45.9% of those presenting tuberculous lesions in the genito-urinary system died from generalized miliary tuberculosis compared with only 3% of those with no tubercular foci. It is hypothesized that individuals who develop genito-urinary tuberculosis have an impaired resistance to infection in general. Renal lesions were twice as frequent as those in the prostate and 3 times as frequent as those in other genital organs. In tuberculosis of the genital system the prostate seminal vesicle and epididymis were all involved in 63% of cases the prostate alone in 29% and the seminal vesicle or epididymis alone in no cases. Involvement of the prostate is believed to succeed renal involvement in a high proportion of cases. The 6 patients who had an epididymectomy prior to death all died from tuberculosis with both prostate and seminal vesicles affected indicating that the procedure is not effective in genital tuberculosis. A clinical diagnosis of tuberculosis was recorded in 80% of patients with genito-urinary tuberculosis but genito-urinary disease was recognized in only 18%. Only half the patients with tuberculous renal cavity and 40% of those with necrotic but unexcavated renal lesions presented urinary symptoms. Determination of the sequence in which organs of the genito-urinary system are affected will require a meticulous search for minute tuberculous foci prior to clinical manifestation of disease or development of lesions noted at necropsy. Such study will permit confirmation of the assumption that tuberculous lesions of the genital organs are not secondary to tuberculous lesions in the kidney.