Prostate tuberculosis by Transurethral Resection

of Prostate (TURP): the first case report in Riau

Afdal Afdal1, Aidil Rahman Novesar2

1
Faculty of Medicine, Universitas Riau, Division of Urology, Arifin Achmad Hospital,
Pekanbaru, Indonesia
2
Faculty of Medicine, Universitas Padjajaran, Department of Urology, Hasan Sadikin
Hospital, Bandung, Indonesia

Introduction: Prostate location in TB metastases was scarce.

Case presentation: We report a 54-year-old Indonesian male diagnosed with a case of tuberculosis
affecting the prostate. The patient was admitted to the hospital with a chief complaint of acute urinary
retention. Thorax x-ray increased the clinical suspicion of tuberculosis. The transurethral resection of
the prostate (TURP) and the biopsy revealed caseous necrosis mass suggestive of tuberculosis.
Discussion: Prostate tuberculosis is uncommon, and there is little literature on the subject. For our
patient, the symptoms were highly unspecific. The diagnosis was made by histologic analysis by
showing caseous necrosis mass. Prostate tuberculosis is mostly treated medically, with anti-
tuberculosis medications being used.
Conclusion: A robust clinical suspicion is required to avoid misdiagnosis of prostate tuberculosis, as
well as the availability of advanced testing with biopsy confirmation.

Keywords: prostate, transurethral resection, tuberculosis, TURP

INTRODUCTION

Urogenital tuberculosis accounts for a small amount of all extrapulmonary TB cases1. Merely

22% of extrapulmonary TB affects the genitourinary system, while tuberculosis of the

prostate gland affects only 2.7 % of genitourinary tuberculosis cases 2. Prostate location in TB

metastases was very rare1. Instead, it shows non-specific clinical and radiological symptoms

that might lead to misdiagnosis and treatment delays 3. We reported a case of prostate

tuberculosis that was found by transurethral resection of the prostate (TURP) procedure.

CASE PRESENTATION

Male, 54 years old, came to policlinic presented with acute urinary retention. A urinary

catheter was inserted five hours before admission to relieve his urinary retention. The patient

had symptoms of Lower Urinary Tract Symptoms (LUTS) for one year. However, the signs

had been worsening in the past two months. There was no history of prostate disease in his

family. The patient’s occupation was a private employee. The patient had a history of urinary

retention one and a half months ago. The patient underwent a trial without catheter (TWOC)

with tamsulosin 1x0.4 mg daily for one month. However, the symptoms recurred. The patient

denied weight loss, chronic cough, or night sweating.

There was no abnormality on the physical examination of the lungs. However, the

digital rectal examination (DRE) shows prostate enlargement with benign characteristics.

Based on findings on clinical manifestations and tests, the patient was diagnosed with

suspected benign prostatic hyperplasia (BPH).

Blood work was regular with no signs of renal impairment. Transabdominal USG

shows a prostate enlargement of 35 gr with no dilation of the ureter or hydronephrosis. Chest

X-ray shows an increased broncho vascular pattern and infiltrates that fill almost entire both

lungs, with multiple infiltrates, especially on the base of each lung.

Figure 1. Chest Xray

After gave consent for the treatment, the patient then underwent TURP under spinal

anesthesia using a 24Fr resectoscope. The surgery was performed by the first author (AA) as

a urologist surgeon in the hospital. Approximately, 20 gr of prostatic tissue was resected in

60 minutes, and the prostatic tissue was sent for histopathological examination. No

complications were encountered in the perioperative and postoperative periods. The patient

was then discharged on a postoperative day 3 with the remarkable condition and without a

catheter.

Figure 2. Kidney bladder and prostate ultrasound

 The results of histopathological examination of prostate tissue showed several

abnormalities. The macroscopic appearance showed a grey-white, irregular shape, loose-

consistency mass with the volume of ± 9.0 mL. The microscopic appearance showed a

normal gland configuration. However, we also found caseous necrosis mass with lymphocyte,

epithelioid, and Datia Langhans cells, and no malignancy was found. All these findings

suggest chronic tuberculosis infection.

Figure 3. Histopathology of prostate tissue

DISCUSSION

Prostate tuberculosis is uncommon, and there is little literature on the subject. Except

in rare situations, patients with prostatic tuberculosis have non-specific symptoms. Irritative

voiding symptoms, terminal dysuria, or hemospermia are common in this uncommon

situations4. Unfortunately, though, this was not the case with our patient.

Tuberculosis of the upper urinary system can spread downward, contaminating the

lower urinary tract1. Hematogenous, lymphatic, or direct extension from a neighboring

structure can also be used1. Sexual transmission and contamination following an intra-bladder
injection of AFB are highly uncommon. Transmissions have been documented following

trans-urethral endoscopic procedures1. Non-specific granulomatous prostatitis, eosinophilic,

and postoperative prostatitis should all be avoided. Histology is frequently used to make the

differentiation.5

For our patient, the symptoms were highly unspecific. There were no physical

symptoms of tuberculosis. Thus, a histologic analysis diagnosed caseous necrosis mass with

lymphocyte, epithelioid, and Datia Langhans cells.

Prostate tuberculosis is treated chiefly medically, with anti-tuberculosis medications

being used. A study by Chaachou et al.6 proposed a six-month regimen that included a two-

month intense phase including four anti-tuberculosis medications (rifampicin, isoniazid,

ethambutol, and pyrazinamide) and a four-month continuation phase using two anti-

tuberculosis drugs (isoniazid and rifampicin).

CONCLUSION

Prostate tuberculosis is a rare condition with non-specific signs and symptoms, making it

difficult to distinguish from BPH in this patient. Therefore, to avoid a misdiagnosis of the

illness, a strong clinical suspicion is required and the availability of advanced testing with

histopathological confirmation.

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