Tuberculosis Of Genitourinary Tract Research Articles

Integration of Clinicopathologial and Microbiological Evaluation in The Diagnosis of Tubercilous Epididymo- Orchitis- A Case Report

Genitourinary tract Tuberculosis is a common cause of extrapulmonary Tuberculosis caused byMycobacterium tuberculosis. Tuberculosis of the testis and epididymis is rarely associated with scrotal fistula.We present a case of advanced Tuberculous epididymo- orchitis who was unresponsive to emperical therapyfor epididymo- orchitis . Orchidectomy was done to rule out malignancy. Pre operative differentiation ofTuberculous epididymo- orchitis from non tuberculous epididymo- orchitis and testicular tumor isdifficult.Integration of histopathology with microbiological evaluation is important in diagnosis andmanagement of GUTB

Unilateral Tb Epididymo-Orchitis with Scrotal Fistula- A Case Report

Tuberculosis is one of the most common worldwide diseases that remain almost unaltered in prevalence for the past few years. Genitourinary tract tuberculosis is common, but when associated with scrotal fistula it is a rare presentation. A 50 years old male came to the hospital with the complaints of pricking pain and swelling in the left side of scrotum for the past 2 months. He had history of smoking for past 40 years, on examination swelling of size approximately 6x5 cm present in left side of scrotum, globular in shape; penis pushed to right side was present, lower part of the swelling was firm to hard in consistency, left cord thickness was present and fixity to skin was also present. There was a small fistulous opening present in the left side of scrotum with no active discharge. Bilateral inguinal lymph nodes were palpable. This is a rare case presentation of tuberculous epididymo-orchitis with scrotal fistula leading to testis removal. Initially emperical treatment was started for TB epididymoorchitis which turned unresponsive, so he was then proceeded for surgery to avoid further disease progression. This case was managed radiologically, clinically and pathologically. This case report shows how the case was managed and followed up.Since symptoms of TB epididymo-orchitis are milder when compared to the symptoms of pyogenic epididymo-orchitis, they appear to physicians in later advanced stages. Tuberculosis should be considered in Patients with mild symptoms of epididymo-orchitis, mainly in those with HIV, immunosuppressive conditions and endemic areas.

A case of genitourinary tract tuberculosis

We report a case of a 68-year-old male with history of suprarenal insufficiency under steroid therapy, chronic renal disease (CRD), type 2 diabetes mellitus, hypothyroidism and arterial hypertension. The patient was admitted with acute decompensation of CRD subsequent to a urinary tract infection (UTI). Empiric antibiotic course with ceftriaxone was initiated, with clinical and laboratory improvement. No etiologic agent was isolated in urine culture. A week later was readmitted with macroscopic pyuria.

Can Tissue PCR Augment the Diagnostic Accuracy in Genitourinary Tract Tuberculosis?

Purpose: Conventional methods like smear and culture for Mycobacterium tuberculosis are of limited sensitivity and specificity. Histopathological examination (HPE) for the tissues obtained gives inconclusive diagnosis in the absence of caseous necrosis or stained acid-fast bacilli. This study was conducted to determine the utility of tissue PCR for diagnosing tuberculosis of the genitourinary tract (GUTB) and its comparative evaluation with HPE. Patients and Methods: A prospective study was conducted from January 2006 to August 2009 with 78 tissue specimens (renal, prostate, epididymis, penile and soft tissue) from patients with clinically suspected GUTB. All the samples were processed for both PCR and histopathology. Results: In 68 (87.1%) samples, results for both PCR and HPE were coinciding. False positivity and false negativity was observed in 5.1% (4/78) and 7.6% (6/78) samples, respectively. With HPE as the gold standard, PCR has shown sensitivity of 87.5% (95% CI 80.1; 91.9) and specificity of 86.7% (95% CI 74.9; 93.8) and positive agreement between two tests was observed as significant (0.7). PCR results were obtained within a mean period of 3.4 days while those of HPE were obtained in 7.2 days. Conclusions: Tissue PCR is a sensitive and specific method for obtaining early and timely diagnosis of GUTB. Application of tissue PCR results can augment the diagnostic accuracy in histopathologically labelled granulomatous inflammations.

Primary tuberculosis of glans penis: a case report.

An extremely rare form of genitourinary tract tuberculosis (TB) is TB of glans, being reported in 139 cases up to 1971.(1-4) Penile glans may be affected through different mechanisms(1,2,4,5): primary, as an ulcerative lesion of glans; secondary, which is due to TB of other parts in urinary tract system--usually extended through urethra; and finally, hematogenous. Long ago, circumcision was a risk factor when mycobacterium could enter the wounded glans from affected circumcision operators.(3,6) At present, TB of glans in adults is usually a primary or secondary form. Primary glans TB can be acquired by either intercourse with a patient suffering from genital TB, or contact with contaminated fabric. The secondary form is the subsequent complication of lung tuberculosis or other organs involvement.(3) We report a case of primary glans TB, which is, to our best knowledge, the first report in Iran.

Tuberculous Epididymitis Presenting as Huge Scrotal Tumor

Genitourinary tract tuberculosis is a specific chronic granulomatous infection. However, epididymal tuberculosis presented as a huge scrotal mass is uncommon. We report one case of epididymal tuberculosis that was noted 5 months after the prostate biopsy and was managed with unilateral simple epidymo-orchiectomy. Antituberculous drugs have been given as the medical treatment of tuberculosis postoperatively. Urinalysis became normalized and the scrotal ultrasonography showed normal left epididymis and testicle at 6-month follow up.

An update on lower urinary tract tuberculosis

Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guérin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.

Reproductive tract tuberculosis and male infertility

Infertility is an uncommon manifestation of genitourinary tract tuberculosis. Anatomic obstruction by granulomas or distortion of the normal anatomy by fibrosis surrounding the reproductive tract structures is the commonest cause of infertility. The diagnosis is usually based on a suggestive history along with evidence of granulomatous infection on a tissue sample. The management depends on the site of obstruction and surgery is usually helpful only in cases with discrete ejaculatory duct obstruction. However, most other patients are candidates for in-vitro fertilization and have a prognosis similar to that in men with other causes of obstructive azoospermia.

Tuberculosis of the Prostate

Tuberculosis of genitourinary tract is common in Taiwan. We present two cases of tuberculosis of the prostate with their CT findings.

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

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.