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Urogenital tuberculosis

Authors
R Kasi Visweswaran, MD, DM, FRCP (Edin)
Vernon M Pais, Jr, MD
Jodie Dionne-Odom, MD
Section Editors
C Fordham von Reyn, MD
Gary C Curhan, MD, ScD
Deputy Editors
Elinor L Baron, MD, DTMH
Alice M Sheridan, MD

INTRODUCTION

Urogenital tuberculosis (TB) is the second most common form of extrapulmonary tuberculosis after lymph node involvement [1]. Urogenital TB occurs in 2 to 20 percent of individuals with pulmonary tuberculosis [1-3]. Among patients with miliary disease, hematogenous seeding of the urogenital tract occurs in 25 to 62 percent of cases [1]. In one review including more than 9000 patients with TB, urogenital TB affected two males to each female, with a mean age of 40 years (range 5 to 90 years) [4].

Issues related to urogenital TB are reviewed here; issues related to pulmonary and other forms of TB are discussed separately. (See related topics.)

Rarely, tuberculous bacilli may enter the urinary tract via intravesical instillation of the attenuated live Bacillus Calmette-Guérin (BCG) to treat bladder cancer; this is discussed separately. (See "Infectious complications of intravesical BCG immunotherapy".)

PATHOGENESIS

Issues related to pathogenesis of urogenital tuberculosis (TB) are discussed here; general issues related to pathogenesis of TB are discussed separately. (See "Natural history, microbiology, and pathogenesis of tuberculosis".)

Renal and urologic tuberculosis — Tuberculosis involving the kidney and urologic system has two forms. The classical presentation occurs most commonly; it primarily involves the urinary collecting system (including renal pelvis, calyces, ureters, and bladder). Less commonly, renal parenchymal lesions occur, including interstitial nephritis and glomerulonephritis [5].

                       
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Literature review current through: Sep 2017. | This topic last updated: Aug 02, 2017.
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References
Top
  1. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr 2017; 5.
  2. Abbara A, Davidson RN, Medscape. Etiology and management of genitourinary tuberculosis. Nat Rev Urol 2011; 8:678.
  3. Bentz RR, Dimcheff DG, Nemiroff MJ, et al. The incidence of urine cultures positive for Mycobacterium tuberculosis in a general tuberculosis patient population. Am Rev Respir Dis 1975; 111:647.
  4. Figueiredo AA, Lucon AM, Junior RF, Srougi M. Epidemiology of urogenital tuberculosis worldwide. Int J Urol 2008; 15:827.
  5. Chapagain A, Dobbie H, Sheaff M, Yaqoob MM. Presentation, diagnosis, and treatment outcome of tuberculous-mediated tubulointerstitial nephritis. Kidney Int 2011; 79:671.
  6. Simon HB, Weinstein AJ, Pasternak MS, et al. Genitourinary tuberculosis. Clinical features in a general hospital population. Am J Med 1977; 63:410.
  7. Christensen WI. Genitourinary tuberculosis: review of 102 cases. Medicine (Baltimore) 1974; 53:377.
  8. Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol 2001; 12:1307.
  9. Li SY, Wang KL, Chen JY, Chen TW. Tuberculous autonephrectomy. Kidney Int 2006; 69:1924.
  10. García-Rodríguez JA, García Sánchez JE, Muñoz Bellido JL, et al. Genitourinary tuberculosis in Spain: review of 81 cases. Clin Infect Dis 1994; 18:557.
  11. MEDLAR EM, SPAIN DM, HOLLIDAY RW. Post-mortem compared with clinical diagnosis of genito-urinary tuberculosis in adult males. J Urol 1949; 61:1078.
  12. Conte G, Iavarone M, Santorelli V, De Nicola L. Acute renal failure of unknown origin. Don't forget renal tuberculosis. Nephrol Dial Transplant 1997; 12:1260.
  13. Chattopadhyay A, Bhatnagar V, Agarwala S, Mitra DK. Genitourinary tuberculosis in pediatric surgical practice. J Pediatr Surg 1997; 32:1283.
  14. Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and tubulointerstitial nephritis: an intriguing puzzle. Kidney Int 2011; 79:579.
  15. van der Meulen J, de Jong GM, Westenend PJ. Acute interstitial nephritis during rifampicin therapy can be a paradoxical response: a case report. Cases J 2009; 2:6643.
  16. Onal IK, Bayraktar Y, Unal S. Paradoxical deterioration during the course of antituberculous treatment. J Natl Med Assoc 2006; 98:954.
  17. Sun L, Yuan Q, Feng J, et al. Be alert to tuberculosis-mediated glomerulonephritis: a retrospective study. Eur J Clin Microbiol Infect Dis 2012; 31:775.
  18. Coventry S, Shoemaker LR. Collapsing glomerulopathy in a 16-year-old girl with pulmonary tuberculosis: the role of systemic inflammatory mediators. Pediatr Dev Pathol 2004; 7:166.
  19. Shribman JH, Eastwood JB, Uff J. Immune complex nephritis complicating miliary tuberculosis. Br Med J (Clin Res Ed) 1983; 287:1593.
  20. Kennedy AC, Burton JA, Allison ME. Tuberculosis as a continuing cause of renal amyloidosis. Br Med J 1974; 3:795.
  21. le Roux DM, Pillay K, Nourse P, et al. Systemic amyloidosis complicating multidrug-resistant tuberculosis in childhood. Pediatr Infect Dis J 2012; 31:994.
  22. Aliyu MH, Aliyu SH, Salihu HM. Female genital tuberculosis: a global review. Int J Fertil Womens Med 2004; 49:123.
  23. Mondal SK, Dutta TK. A ten year clinicopathological study of female genital tuberculosis and impact on fertility. JNMA J Nepal Med Assoc 2009; 48:52.
  24. Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 2000; 161:1376.
  25. Lima NA, Vasconcelos CC, Filgueira PH, et al. Review of genitourinary tuberculosis with focus on end-stage renal disease. Rev Inst Med Trop Sao Paulo 2012; 54:57.
  26. Marks LS, Poutasse EF. Hypertension from renal tuberculosis: operative cure predicted by renal vein renin. J Urol 1973; 109:149.
  27. Nzerue C, Drayton J, Oster R, Hewan-Lowe K. Genitourinary tuberculosis in patients with HIV infection: clinical features in an inner-city hospital population. Am J Med Sci 2000; 320:299.
  28. Marques LP, Rioja LS, Oliveira CA, Santos OD. AIDS-associated renal tuberculosis. Nephron 1996; 74:701.
  29. Hemal AK, Gupta NP, Rajeev TP, et al. Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology 2000; 56:570.
  30. Figueiredo AA, Lucon AM, Gomes CM, Srougi M. Urogenital tuberculosis: patient classification in seven different groups according to clinical and radiological presentation. Int Braz J Urol 2008; 34:422.
  31. Lattimer JK, Reilly RJ, Segawa A. The significance of the isolated positive urine culture in genitourinary tuberculosis. J Urol 1969; 102:610.
  32. Mortier E, Pouchot J, Girard L, et al. Assessment of urine analysis for the diagnosis of tuberculosis. BMJ 1996; 312:27.
  33. Moussa OM, Eraky I, El-Far MA, et al. Rapid diagnosis of genitourinary tuberculosis by polymerase chain reaction and non-radioactive DNA hybridization. J Urol 2000; 164:584.
  34. Amin I, Idrees M, Awan Z, et al. PCR could be a method of choice for identification of both pulmonary and extra-pulmonary tuberculosis. BMC Res Notes 2011; 4:332.
  35. Chawla A, Chawla K, Reddy S, et al. Can tissue PCR augment the diagnostic accuracy in genitourinary tract tuberculosis? Urol Int 2012; 88:34.
  36. Hillemann D, Rüsch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF system. J Clin Microbiol 2011; 49:1202.
  37. Becker JA. Renal tuberculosis. Urol Radiol 1988; 10:25.
  38. Kollins SA, Hartman GW, Carr DT, et al. Roentgenographic findings in urinary tract tuberculosis. A 10 year review. Am J Roentgenol Radium Ther Nucl Med 1974; 121:487.
  39. Gaudiano C, Tadolini M, Busato F, et al. Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay. Abdom Radiol (NY) 2017.
  40. Vijayaraghavan SB, Kandasamy SV, Arul M, et al. Spectrum of high-resolution sonographic features of urinary tuberculosis. J Ultrasound Med 2004; 23:585.
  41. Figueiredo AA, Lucon AM, Arvellos AN, et al. A better understanding of urogenital tuberculosis pathophysiology based on radiological findings. Eur J Radiol 2010; 76:246.
  42. Bhatt C, Lodha S. Paraspinal sinuses? Do remember renal tuberculosis. BMJ Case Rep 2012; 2012.
  43. Teo EY, Wee TC. Images in clinical medicine: Renal tuberculosis. N Engl J Med 2011; 365:e26.
  44. Dinnes J, Deeks J, Kunst H, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess 2007; 11:1.
  45. Raghavaiah NV. Tuberculosis of the male urethra. J Urol 1979; 122:417.
  46. Raut VS, Mahashur AA, Sheth SS. The Mantoux test in the diagnosis of genital tuberculosis in women. Int J Gynaecol Obstet 2001; 72:165.
  47. Feng Y, Diao N, Shao L, et al. Interferon-gamma release assay performance in pulmonary and extrapulmonary tuberculosis. PLoS One 2012; 7:e32652.
  48. ROSS JC. Renal tuberculosis. Br J Urol 1953; 25:277.
  49. Mochalova TP, Starikov IY. Reconstructive surgery for treatment of urogenital tuberculosis: 30 years of observation. World J Surg 1997; 21:511.
  50. Sporer A, Auerbach O. Tuberculosis of prostate. Urology 1978; 11:362.
  51. Indudhara R, Vaidyanathan S, Radotra BD. Urethral tuberculosis. Urol Int 1992; 48:436.
  52. Trauzzi SJ, Kay CJ, Kaufman DG, Lowe FC. Management of prostatic abscess in patients with human immunodeficiency syndrome. Urology 1994; 43:629.
  53. Lübbe J, Ruef C, Spirig W, et al. Infertility as the first symptom of male genitourinary tuberculosis. Urol Int 1996; 56:204.
  54. Vasanthi R, Ramesh V. Tuberculous infection of the male genitalia. Australas J Dermatol 1991; 32:81.
  55. Singal A, Pandhi D, Kataria V, Arora VK. Tuberculosis of the glans penis: an important differential diagnosis of genital ulcer disease. Int J STD AIDS 2017; :956462417703027.
  56. Ilhan AH, Durmuşoğlu F. Case report of a pelvic-peritoneal tuberculosis presenting as an adnexial mass and mimicking ovarian cancer, and a review of the literature. Infect Dis Obstet Gynecol 2004; 12:87.
  57. Namavar Jahromi B, Parsanezhad ME, Ghane-Shirazi R. Female genital tuberculosis and infertility. Int J Gynaecol Obstet 2001; 75:269.
  58. Chavhan GB, Hira P, Rathod K, et al. Female genital tuberculosis: hysterosalpingographic appearances. Br J Radiol 2004; 77:164.
  59. Parikh FR, Nadkarni SG, Kamat SA, et al. Genital tuberculosis--a major pelvic factor causing infertility in Indian women. Fertil Steril 1997; 67:497.
  60. Liomba NG, Chipangwi JD. Female Genital Tuberculosis in Malawi--a report of 90 cases. J Obstet Gynaecol East Cent Africa 1982; 1:69.
  61. Sutherland AM. Gynaecological tuberculosis since 1951. J Obstet Gynaecol 1997; 17:119.
  62. Shah HU, Sannananja B, Baheti AD, et al. Hysterosalpingography and ultrasonography findings of female genital tuberculosis. Diagn Interv Radiol 2015; 21:10.
  63. Tripathy SN, Tripathy SN. Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynaecol Obstet 2002; 76:159.
  64. Figueiredo AA, Lucon AM. Urogenital tuberculosis: update and review of 8961 cases from the world literature. Rev Urol 2008; 10:207.
  65. Psihramis KE, Donahoe PK. Primary genitourinary tuberculosis: rapid progression and tissue destruction during treatment. J Urol 1986; 135:1033.
  66. Shin KY, Park HJ, Lee JJ, et al. Role of early endourologic management of tuberculous ureteral strictures. J Endourol 2002; 16:755.
  67. Goel A, Dalela D. Options in the management of tuberculous ureteric stricture. Indian J Urol 2008; 24:376.
  68. Sourial MW, Brimo F, Horn R, Andonian S. Genitourinary tuberculosis in North America: A rare clinical entity. Can Urol Assoc J 2015; 9:E484.
  69. Ferrie BG, Rundle JS. Genito-urinary tuberculosis in Glasgow 1970 to 1979: a review of 230 patients. Scott Med J 1985; 30:30.
  70. Ramanathan R, Kumar A, Kapoor R, Bhandari M. Relief of urinary tract obstruction in tuberculosis to improve renal function. Analysis of predictive factors. Br J Urol 1998; 81:199.
  71. Wong SH, Lau WY. The surgical management of non-functioning tuberculous kidneys. J Urol 1980; 124:187.
  72. Cek M, Lenk S, Naber KG, et al. EAU guidelines for the management of genitourinary tuberculosis. Eur Urol 2005; 48:353.
  73. Fischer M, Flamm J. [The value of surgical therapy in the treatment of urogenital tuberculosis]. Urologe A 1990; 29:261.
  74. Kerr WK, Gale GL, Peterson KS. Reconstructive surgery for genitourinary tuberculosis. J Urol 1969; 101:254.
  75. Singh V, Sinha RJ, Sankhwar SN, Sinha SM. Reconstructive surgery for tuberculous contracted bladder: experience of a center in northern India. Int Urol Nephrol 2011; 43:423.
  76. Gokce G, Kilicarslan H, Ayan S, et al. Genitourinary tuberculosis: a review of 174 cases. Scand J Infect Dis 2002; 34:338.
  77. Butler MR, O'Flynn JD. Reactivation of genito-urinary tuberculosis: a retrospective review of 838 cases. Eur Urol 1975; 1:14.
  78. Weir MR, Thornton GF. Extrapulmonary tuberculosis. Experience of a community hospital and review of the literature. Am J Med 1985; 79:467.