Author:
Jayarajah Umesh,Gunawardene Milan,Willaraarachchi Munipriya,Chandrasiri Shirani,Udayakumaran Perumal,Sosai Cherine,Abeygunasekera Anuruddha
Abstract
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.
Publisher
Springer Science and Business Media LLC
Reference28 articles.
1. Tuberculosis Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/tuberculosis.
2. Jha SK, Budh DP. Genitourinary tuberculosis. [Updated 2021 Jul 6]. In: StatPearls. Treasure Island: StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK557558/.
3. Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, et al. Urinary tuberculosis: a cohort of 79 adult cases. Renal Fail. 2015;37(7):1157–63.
4. Abeygunasekera A. Genitourinary tuberculosis. Sri Lanka J Urol. 2010;10(1):12–7.
5. National Programme for Tuberculosis Control and Chest Diseases (NPTCCD), Genitourinary tuberculosis in Sri Lanka. 2019 (Unpublished, personal communications).
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献