What is Genito-Urinary Tuberculosis (GUTB)?
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When Tuberculosis infects the organs of Genito-Urinary system, it is called GUTB. It is the second most common form of Extra Pulmonary TB after Lymph Node TB. The organs usually involved in the usual frequency are as under:-
- Kidney – urinary tract involved by direct extension-Adrenals
- Bladder
- Fallopian tubes
- Scrotum-Testes, Epididymis, Prostrate, Penis, Urethra
What are the causes of Genito-Urinary Tuberculosis?
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- Active GUTB comes 5 -25 years after first infection, so uncommon in young children.
- Approx. 8-15% of patients of pulmonary TB at risk of developing GUTB.
- Patients present symptoms referred to organ involved or have unexplained and long-standing urological symptoms.
Symptoms of Genito-urinary TB?
- From Vague symptoms to chronic kidney disease
- Repeating or resistant urinary tract infection
- Sterile pyuria, sometimes with or sometimes without haematuria
- Irritative voiding symptoms of urgency, frequency or dysuria-in almost 50% cases
- Flank pain
- Acute pyelonephritis
- Non-healing wounds
- Sinuses or fistulae
- Hemospermia
- Fever
- Weight loss
- Anorexia
- Backache
- Abdominal pain
How to confirm diagnosis?
- Presence of Sterile pyuria in urine is taken as a classic finding. Mycobacterium in urine is the primary test for diagnosis of GUTB. Best is to examine five consecutive early-morning specimens of urine
- Detecting mycobacterium in urine/body fluid by culture on routine media. These cultures require 6-8 weeks in Lowenstein-Jensen media. In conventional cultural media the sensitivity is 80- 97%
- Radiographic assessment by X-rays. By plain X-ray abdomen we can see renal calcification. Plain radiographs of chest and spine to be done to find out about active or old pulmonary or spinal locus
- Early Intravenous Urography shows parenchymal necrosis and calcification
- MRI can be used. Useful when renal function has been compromised, in pregnancy, or due to allergy to contrast media. We get excellent morphological details of kidneys and ureters
- Radiometric liquid culture systems give rapid and sensitive results. The Polymerase chain reaction (PCR) gives DNA findings from even very few bacteria. It is rapid and upto 88% specific in detecting urine acid-fast bacilli (AFB).
- Ultrasound reveals renal calyceal dilation and evidence of obstruction
- Computed tomography (CT scan) is able to identify calyceal and Infundibular abnormalities, retroperitoneal, Hydronephrosis, renal parenchymal destruction, as also adrenal, prostatic and seminal vesicle abnormalities
Treatment of Genito-Urinary TB
- Standard 6 month short-course chemotherapy (using 4 drugs including rifampicin and pyrazinamide) is updated to make it for 9-12 months treatment course
- Corticosteroids have no real proven role in treatment of GUTB
- Role of surgery in GUTB has reduced due to effective anti-TB therapy, but it can still be used alongside medical treatment
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Prognosis of Genitourinary Tuberculosis (GUTB)
- Prognosis is good when the infection is by antibiotic-susceptible strain.
- Antibiotic resistant strains of tuberculosis require intensive antibiotic regime.
- Recovery likelihood gets affected due to the many undesirable adverse-effects of the anti-TB treatment.
Effects of TB on Different Organs of Genito-Urinary Tract
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KIDNEY AND URETER
- Can be long-standing nature with minimal symptoms.
- The patient could be asymptomatic or have sterile pyuria
- Actual haematuria in only 10% but microscopic presence in 50% cases
- Rare to see acute renal pain
- Chronic dull ache may be present
- Intravenous urography shows stricture in lower ureteric area
- Cystogram shows thimble bladder with vesicoureric reflux
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URINARY BLADDER
- Bladder involvement secondary to renal infection-seen in one-third patients
- In acute phase there are Irritative voiding symptoms
- Increased frequency of micturition
- Urinary incontinence
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PROSTATE, PENIS & URETHRA
- Uncommonly involved.
- Causes “beefy redness”, external ulcerations, dilatation of prostatic urethra
- Prostate shows nodularity on rectal examination like a malignancy
- Penis may manifest as ulcer as in sexually transmitted diseases or tumor.
- Penis can show with cold abscess, impotence or penile deformity
- Urethral involvement leading to stricture formation
- Hematospermia seen in upto 11% cases
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EPIDIDYMIS & TESTES
- Infection starting from Globus minor
- Presenting as painful swelling of scrotal mass
- Difficult to distinguish clinically from epididymo-orchitis
- Leads to vassal obstruction and infertility
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PELVIC DISEASE IN FEMALES
- Presents as infertility
- Chronic pelvic pain
- Changes in menstrual pattern
- Amenorrhea
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ADRENAL GLANDS
- Adrenocortical insufficiency seen in involvement of adrenal glands
- Bilateral involvement causes complete necrosis
- TB is inactive in classic Addison’s disease, results in partially calcified granulomas
- When TB reactivated, results in symptoms of TB, causing adrenal insufficiency
