EFFECTS OF TUBERCULOSIS ON GENITOURINARY SYSTEM

Abstract

Background: Genitourinary Tuberculosis (GUTB) is a common site of extrapulmonary tuberculosis. The disease involves the kidneys, ureters, bladder, or genital organs. Clinical symptoms develop 10 – 15 years after primary infection. Only one-quarter of patients with
GUTB have a known history of TB and about half of these patients have chest radiography findings. The current study aimed to determine the effects of GUTB.
Methods: The included patients were successive cases with a diagnosis of genitourinary tuberculosis. A total of 62 cases were reported with the diagnosis of genitourinary tuberculosis. PCR for MTb was done in 37 cases. Radiological evaluation included chest X-ray, KUB in all cases, and intravenous urogram when serum creatinine was normal. FNAC was performed in cases with serosal masses. All patients received antitubercular drug therapy with 4 drugs (Rifampicin, Ethambutol, Isoniazid, and Pyrazinamide) for 2 months followed by 2 drugs (Rifampicin and Isoniazid) for 7 months.
Results: Positive AFB staining and positive MTb culture in urine were seen in 31.37% and 41.17% of cases, respectively, confirming the presence of Mycobacterium tuberculosis in some GUTB patients. Positive PCR for MTb in urine is present in 67.56% of cases (in a subset of 37 patients). MTb culture in pus is only observed in 4 out of 7 cases, suggesting its less frequent occurrence compared to other positive findings. Sterile urine is found in 78.95% of cases, and Radiological abnormalities (IVU/NCCT/MUCG) suggestive of GUTB was found in 46/57 (80.7%) cases. Bladder biopsy was positive in 12/25(48%) cases done. A comparison of urinary PCR with urine for AFB staining urine for MTb culture and bladder biopsy was done.
Conclusion: The urinary (PCR) stands out as the most sensitive indicator among all microbiological tests. When coupled with radiological abnormalities, it significantly expedites the diagnosis of genitourinary tuberculosis. Optimal treatment involves a combination of multidrug chemotherapy and judicious surgery, as necessary. It is highly advisable to make every effort to reconstruct the urinary tract due to the rewarding outcomes associated with this approach. However, in cases where tissue is infected and irreparably damaged, the most effective course of action is ablating the affected tissue.