Diagnosis Of Urinary Tuberculosis Research Articles

The clinical value of endoscopy detect and mucosa biopsy in the diagnosis of urinary tuberculosis

Objective To study the clinical value of cystoscope and ureterscopy and mucosa biopsy in the diagnosis of urinary tuberculosis. Methods From May 2007 to December 2012, 126 patients with urinary tuberculosis were observed by cystoscope and (or) ureteroscopy and mucosa biopsy. The clinical data were compared with urinary sediment and screenage detection at the same time. Results Of 126 patients, 66 patients were precisely diagnosed as positive by cystoscope and bladder mucosa biopsy, and 15 patients who underwent ureterscopy were diagnosed as positive, the positive rate of endoscopic examination was 64.3%(81/126). The positive rate of bladder or ureter biopsy was higher than those of urinary sediment detection (21.4%, 27/126) and screenage detection (31.0%, 39/126) (P<0.01). Conclusions Cystoscope detection and mucosa biopsy has a key role in the diagnosis of urinary tuberculosis due to high sensitive, specific and safe. It is an effective alternative to diagnose the atypical urinary tuberculosis through ureterscopy. Key words: Tuberculosis; Urogenital System; Biopsy, Needle

GeneXpert MTB/RIF assay in the diagnosis of urinary tuberculosis from urine specimens

Conventional bacteriological methods are not generally helpful in diagnosing urinary tuberculosis (UTB). GeneXpert is endorsed for the detection of pulmonary tuberculosis, whereas the data on its utility for urine specimens is limited. In this study, we aimed to evaluate its performance on urine specimens in a country with high TB incidence. A total of 163 suspected UTB patients were consecutively enrolled in the analysis, including 37 (22.7%) culture-positive and 44 (27.0%) clinically diagnosed UTB cases. Compared with conventional culture, the sensitivity of GeneXpert (94.6%) was significantly higher than that of smear microscopy (40.5%, P < 0.001). When setting clinical diagnosis as gold standard, 51 out of 81 clinically diagnosed UTB cases were detected by GeneXpert, demonstrating a sensitivity of 63.0%, which was significantly higher than that of smear microscopy (18.5%, P < 0.001) and culture (45.7%, P = 0.027), respectively. In addition, the proportion of UTB cases in the migrant population was significantly higher than that in the resident population (P = 0.019). To conclude, our data demonstrate that GeneXpert outperforms AFB smear and culture for the detection of MTB in urine samples, which provides an alternative for the diagnosis of UTB. The migrant population and previously diagnosed TB cases are high risk factors for developing UTB cases.

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.

Renal tuberculosis and iliopsoas abscess: Two case reports.

The urinary system is the second most commonly affected site of extrapulmonary tuberculosis (TB). Due to the diverse and atypical clinical manifestations of urinary TB, the disease is easy to misdiagnose. In the present study, two cases of renal TB are reported, which had completely different clinical manifestations. The first case is a female who presented with loin pain and fever. Purified protein derivative (PPD) and TB antibody tests were negative and computed tomography (CT) scans showed a low density focus in the right kidney with an iliopsoas abscess. The typical CT findings indicated renal tuberculosis. Anti-TB drugs were effective proved the diagnosis. The second case is a male who presented with intermittent gross hematuria. Acid-fast bacilli in urine and TB antibody tests were positive. CT scans revealed a low density focus in the unilateral kidney with a slight expansion of the pelvis, calices and ureter. The patients were treated with the anti-TB drugs and the clinical manifestations disappeared. The diagnosis of urinary TB is challenging in certain cases; when there is no response to the usual antibiotics in patients with fever or gross hematuria, TB should be suspected. CT is the mainstay for investigating possible urinary TB.

The Spermiogram in Urogenital Tuberculosis

In 50 patients, all under 40 years old, with a diagnosis of urinary tuberculosis, a spermiogram, in order to see if there was any cytomorphological or biochemical alteration, was performed. They were divided into two groups: the first one including patients showing clinical alteration of the genital tract, and the second one including patients without any clinical symptomatology, eg. at the external genitalia. The modification of the spermiogram in accordance with the evolution of the urinary tuberculous lesion and the specific treatment employed, have also been evaluated. All patients with clinical alterations in the genital tract, showed also alterations in the cytomorphological and/or in the biochemical studies. 75% of the patients without genital lesions showed oligoasthenozoospermia. In spite of the treatment established, no improvements were observed in the spermiogram.

Urinary Tuberculosis: Ten Years' Experience

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18–71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.

Clinical relevance of nucleic acid amplification test for patients with urinary tuberculosis during antituberculosis treatment

The nucleic acid amplification test (NAAT) has been valuable in the diagnosis of urinary tuberculosis; however, no studies have attempted to determine the significance of NAAT post treatment. We encountered three patients with urinary tuberculosis who underwent sequential NAAT during antituberculosis chemotherapy and post treatment. All patients were diagnosed as having urinary tuberculosis by positive NAAT and specific renal deformity revealed by imaging. In two of the three patients, positive culture results were obtained and one was negative in standard culture. During antituberculosis chemotherapy, a negative NAAT was obtained from 3 to 5 months after the start of treatment and no positive culture results were obtained during the same period. At the end of chemotherapy, 6 months or more after the start of medication, all patients had negative NAAT results. These results suggest that NAAT for Mycobacterium tuberculosis provides an effective and rapid detection method for urinary tuberculosis both pre- and post-treatment.

Spectrum of high-resolution sonographic features of urinary tuberculosis.

To evaluate the high-resolution sonographic features of urinary tuberculosis. During a period of about 3 years 6 months, there were 45 patients with sonographic features of urinary tuberculosis that was subsequently proved by urine culture or biopsy. The clinical symptoms, urinalysis findings, sonographic features, urine smear findings, and biopsy findings were recorded. The most common symptoms were dysuria and frequency of micturition. Sonographic features included parenchymal masses, cavities, mucosal thickening of the collecting system and urinary bladder, stenosis of the collecting system, a contracted urinary bladder, vesicoureteric reflux, and calcifications. The proof of tuberculosis was by urinalysis, culture, and biopsy. High-resolution sonography in appropriate clinical situations is useful in diagnosis of urinary tuberculosis. The various high-resolution sonographic findings in urinary tuberculosis are illustrated. The distinguishing features are visualization of involvement of multiple sites and multiple stages of disease in the same patient.

Tuberculosis and infertility in men.

In 50 patients, all under 40, a diagnosis of urinary tuberculosis and a spermiogram have been made in order to see if there was any cytomorphological or biochemical alteration. We have divided them into two groups: the first one including the patients showing clinical alterations of the genital structures, and the second one including those for whom it had not been possible to demonstrate any clinical symptomatology, e.g. at the external genitalia. The modification of the spermiogram in accordance with the evolution of the urinary tuberculosis lesion and the specific treatment employed has also been evaluated. All patients with clinical alterations in the genital structures showed alterations in the cytomorphological and/or in the biochemical study. 75% of the patients without genital lesions showed oligoasthenozoospermia. We have not been able to observe any improvement whatsoever in the spermiogram in spite of the treatment established.