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Chapter 20 : Urogenital Tuberculosis
Category: Clinical Microbiology; Bacterial Pathogenesis
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Urogenital tuberculosis is responsible for 30 to 40% of extrapulmonary tuberculosis cases, being second only to lymph node involvement. Urogenital tuberculosis most frequently affects the kidneys, renal infection being slowly progressive, asymptomatic, and highly destructive, with instances of unilateral renal loss of function and renal failure on diagnosis. Tuberculosis affects the entire male genital tract, with lesions in the prostate, seminal vesicles, vas deferens, epididymis, Cooper glands, penis, and testicles, the last through contiguity with the epididymis, since the blood- testicle barrier plays a protective role. Female genital tuberculosis is secondary to hematogenous spread from a primary focus, generally in the lungs or, less commonly, through lymphatic spread from tuberculosis of abdominal. Urogenital tuberculosis seems to be very important in AIDS patients. Identification of the tuberculosis bacillus in the urine is achieved through Ziehl-Neelsen`s acidfast staining technique or through urine culture in Lowenstein-Jensen medium. Over half (54.9%) the patients with urogenital tuberculosis undergo surgery. Most authors recommend nephrectomy without ureterectomy in cases of unilateral renal dysfunction to avoid relapse, eliminate irritative voiding symptoms, treat hypertension, and avoid abscess formation. The author proposes that any patient presenting with gross hematuria, persistent microscopic hematuria or pyuria, recurrent urinary tract infection, and persistent irritative micturition symptoms be investigated for urogenital tuberculosis, with six urine samples being collected for culture or PCR. The author proposes a periodic urine examination for hematuria or pyuria in patients with previous pulmonary tuberculosis or immunosuppressed subjects. Bactericidal and bacteriostatic drugs are used as the pharmacological treating urogenital tuberculosis.
Key Concept Ranking
- Urinary Tract Infections
Post-contrast phase of abdominal CT in an AIDS patient, with bilateral renal abscesses and dilatation of the collecting system on the right. Retroperitoneal lymph node enlargement with central necrosis is apparent (arrow). From reference 20 , with permission.
MRI (A) and CT (B and C) of patients with unilateral renal tuberculosis, with dilatation of the collecting system (caliectasis) and thinning of the renal parenchyma. There is no dilatation of the renal pelvis. From reference 20 , with permission.
Sequential exams of patient with urogenital tuberculosis. (A) Initial intravenous urography (IU) with right kidney dysfunction and normal left kidney and bladder. (B) IU after 10 months, with development of contracted bladder and ureterohydronephrosis on the left. (C) Voiding cystography showing high-grade vesicoureteral reflux on the left as a cause of dilatation of the collecting system. From reference 20 , with permission.
Sequential exams of a patient with urogenital tuberculosis. (A) Initial IU with normal right kidney and left kidney with ureterohydronephrosis due to stenosis of the middle ureter (arrow) and intrarenal stenoses without pelvic dilatation (typical tuberculosis feature). (B) Cystography with normal bladder and no reflux. (C and D) IU and voiding cystography after 6 months without treatment, showing renal dysfunction on the left and ureterohydronephrosis on the right, with contracted bladder and bilateral vesicoureteral reflux (high grade on the right) as a cause of ureterohydronephrosis. From reference 20 , with permission.
Voiding urethrocystography showing contracted bladder, no vesicoureteral reflux, and prostate tuberculosis, with dilatation and irregularities of the prostatic urethra. From reference 20 , with permission.
Frequency of affected urogenital organs
Comparison of patients from developed and developing countries b
Features of immunocompromised and nonimmunocompromised patients with urogenital tuberculosis a