Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

Abstract

Background Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. Methods Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6–96). Results There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26–75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. Conclusions The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

Renal inflammatory myofibroblastic tumour presenting with a large retroperitoneal abscess

“…8 , 9 Furthermore, due to the rising incidence of renal malignancies and genitourinary TB in the Sri Lankan context, it is essential that histological assessment and mycobacterial cultures are obtained. 10 - 12 …”

“…8,9 Furthermore, due to the rising incidence of renal malignancies and genitourinary TB in the Sri Lankan context, it is essential that histological assessment and mycobacterial cultures are obtained. [10][11][12] The diagnosis of an IMT pre-operatively is challenging because they lack specific clinical and radiological features. 2 Even pre-operative biopsies have failed to provide the correct diagnosis.…”

Genital tuberculosis, infertility and assisted reproduction

“…MRI, CT scan, and PET scan are helpful for detecting tubo-ovarian masses [34]. Abnormal CXR findings (healed TB lesions, hilar lymphadenopathy, fibrosis, opacities, and effusions) that may be consistent with TB are found in 8–27% of women with FGTB [35].…”

Tuberculosis as a Complication of BCG in the Treatment of Bladder Carcinoma

“…Unsatisfactory and delayed diagnosis, with imprudent medications, for bladder TB frequently resulted in several urinary complications including contraction of the UB. 3 Miliary tuberculosis (TB) is one of the severest forms of TB. Despite effective treatment, it continues to have a high mortality rate, which is likely to be a consequence of the dissemination of Mycobacterium tuberculosis bacilli, via the lymph and blood, to the tissues.…”