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Urogenital Tuberculosis

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  • Authors: André A. Figueiredo1, Antônio M. Lucon2, Miguel Srougi3
  • Editor: David Schlossberg4
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Núcleo Interdisciplinar de Pesquisa em Urologia and Department of Surgery/Urology, Federal University of Juiz de Fora, Minas Gerais—Brazil; 2: Division of Urology, University of São Paulo Medical School, São Paulo, Brazil; 3: Division of Urology, University of São Paulo Medical School, São Paulo, Brazil; 4: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
  • Received 02 October 2016 Accepted 09 November 2016 Published 13 January 2017
  • André A. Figueiredo, andreavaresef@gmail.com
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  • Abstract:

    Urogenital tuberculosis is the second most frequent form of extrapulmonary tuberculosis. Starting with a pulmonary focus, 2 to 20% of patients develop urogenital tuberculosis through hematogenous spread to the kidneys, prostate, and epididymis; through the descending collecting system to the ureters, bladder, and urethra; and through the ejaculatory ducts to the genital organs. Urogenital tuberculosis occurs at all age ranges, but it is predominant in males in their fourth and fifth decades. It is a serious, insidious disease, generally developing symptoms only at a late stage, which leads to a diagnostic delay with consequent urogenital organ destruction; there are reports of patients with renal failure as their initial clinical presentation. Although the condition has been long recognized by nephrologists, urologists, and infectious disease specialists, urogenital tuberculosis is still largely unknown. Even when suggestive findings such as hematuria, sterile pyuria, and recurrent urinary infections are present, we rarely remember this diagnostic possibility. Greater knowledge of the features of urogenital tuberculosis then becomes relevant and should emphasize the importance of an early diagnosis.

  • Citation: Figueiredo A, Lucon A, Srougi M. 2017. Urogenital Tuberculosis. Microbiol Spectrum 5(1):TNMI7-0015-2016. doi:10.1128/microbiolspec.TNMI7-0015-2016.

Key Concept Ranking

Magnetic Resonance Imaging
0.45421687
Urinary Tract Infections
0.4361247
0.45421687

References

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2017-01-13
2017-09-24

Abstract:

Urogenital tuberculosis is the second most frequent form of extrapulmonary tuberculosis. Starting with a pulmonary focus, 2 to 20% of patients develop urogenital tuberculosis through hematogenous spread to the kidneys, prostate, and epididymis; through the descending collecting system to the ureters, bladder, and urethra; and through the ejaculatory ducts to the genital organs. Urogenital tuberculosis occurs at all age ranges, but it is predominant in males in their fourth and fifth decades. It is a serious, insidious disease, generally developing symptoms only at a late stage, which leads to a diagnostic delay with consequent urogenital organ destruction; there are reports of patients with renal failure as their initial clinical presentation. Although the condition has been long recognized by nephrologists, urologists, and infectious disease specialists, urogenital tuberculosis is still largely unknown. Even when suggestive findings such as hematuria, sterile pyuria, and recurrent urinary infections are present, we rarely remember this diagnostic possibility. Greater knowledge of the features of urogenital tuberculosis then becomes relevant and should emphasize the importance of an early diagnosis.

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Figures

Image of FIGURE 1
FIGURE 1

Post-contrast phase of abdominal computed tomography (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 27 , with permission.

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
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Image of FIGURE 2
FIGURE 2

Magnetic resonance imaging (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 27 , with permission.

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
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Image of FIGURE 3
FIGURE 3

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 27 , with permission.

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
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Image of FIGURE 4
FIGURE 4

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 27 , with permission.

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
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Image of FIGURE 5
FIGURE 5

Voiding urethrocystography showing contracted bladder, no vesicoureteral reflux, and prostate tuberculosis, with dilatation and irregularities of the prostatic urethra. From reference 27 , with permission.

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
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Tables

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TABLE 1

Frequency of affected urogenital organs

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
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TABLE 2

Comparison of patients from developed and developing countries

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016
Generic image for table
TABLE 3

Features of immunocompromised and nonimmunocompromised patients with urogenital tuberculosis

Source: microbiolspec January 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0015-2016

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