Genitourinary tuberculosis

Česká verzia

Authors: Roman Zachoval
Authors place of work: Urologická klinika 3. LF UK a Thomayerovy nemocnice
Published in the journal: Ces Urol 2019; 23(4): 295-308
Category: Review article

Summary

Genitourinary TB is defined as an infectious inflammatory disease of the genitourinary tract (kidneys, ureters, bladder or male and female genital organs), either isolated or combined with other locations, caused by Mycobacterium tuberculosis or Mycobacterium bovis. Genitourinary TB is nowadays the second most common form of TB in countries with serious epidemiological situation and third most common in countries with less serious epidemiological situation.

There are different forms of genitourinary TB, each of which presents with specific features and requires a specific form of therapy. Correct classification of every case is therefore necessary. Genitourinary TB is classified by the affected organ. Renal and bladder TB exist in four different stages of organ involvement. BCG- induced genitourinary TB is a specific form of bladder TB.

Symptoms of genitourinary TB are non-specific. A battery of investigations ought to be performed when genitourinary TB is suspected: physical examination, laboratory tests including urine testing, skin test, imaging and endoscopic investigation with biopsy. In many cases, the diagnosis is not established on the basis of direct evidence of M. tuberculosis in urine, but rather from a mosaic of various investigations results in a multidisciplinary team.

The cornerstones of successful treatment include treatment continuity, patient compliance and adherence to a proper sequence of specific treatment cycles. The patient should undergo treatment with four different anti- TB drugs in the initial phase with maintenance treatment depending on the extent of organ involvement by the disease. Treatment lasts for a minimum of 6 months. BCG- induced TB of the urinary bladder should be treated with 2–3 anti- tuberculotics for 2–4 months provided bladder capacity is preserved. If the bladder becomes shrunken, it will require cystectomy as well as administration of anti- tuberculous treatment.

Surgical treatment is reserved for advanced stages of the disease and in case of complications.

Patients who have been treated for genitourinary TB should be followed up every 6 months for 1–3 years, depending on severity of their disease.

Keywords:

tuberculosis – prostate – urogenital – Mycobacterium tuberculosis – kidney – urinary bladder – epididymis

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