Genitourinary Tuberculosis

Suraj kr. sah

 Contents
• Renal tuberculosis
• Bladder tuberculosis
• TB of prostate and seminal vesicles
• Chronic tuberculous epididymo-orchitis
RENAL TUBERCULOSIS
• Commonly it is secondary, primary may be in
the lungs

• Tuberculous bacilluria occurs with an early

lesion in the renal cortex, and the disease
spreads along the ureter causing tuberculous
ureteritis and stricture ureter
 Renal Tuberculosis
• Aetiology:
– Haematogenous infection from distant focus
– Lesions usually confined to one kidney
– Tuberculous granulomas in renal pyramid coalesce to
form an ulcer
– Untreated lesions in the parenchyma  tuberculous
abscess.
– Necks of the calyces and renal pelvis stenosed by
fibrosis, confine the infection  localised tuberculous
pyonephrosis
• Pyonephrosis or tuberculous renal abscess
extend  perinephric abscess  kidney
progressively replaced by caseous material
(putty kidney), If calcified (cement kidney)
• Miliary tuberculosisKidneys may be
bilaterally affected (Less commonly)
 Clinical features
• Incidence:
– Age : 20- 40 years, Male : Female = 2:1
– Right kidney > left kidney
• Urine frequency increase both day and night ;polyuria
• Sterile pyuria
• Pain
– Suprapubic (Initially)
– Burning pain accompanies micturition (Later)
– Dull ache in loin – Renal
• Haematuria
• Malaise and weight loss
 Clinical features (Contd..)
• Low-level evening pyrexia
• Secondary infection;
– superadded agonising pain referred to the tip of
the penis or to the vulva
– Associated with haematuria and strangury
– High level pyrexia (miliary Tuberculosis)
 Investigation
• Urinalysis (RE, ME and Culture)
– Pus cells
– Ziehl–Neelsen stain – acid-fast bacilli
– Löwenstein–Jensen medium – mycobacteria
• Plain radiograph – areas of calcification
(pseudocalculi)
• Intravenous urography
• Chest radiography
• Cystoscopy
Intravenous urogram showing a
small localised tuberculous lesion
with hydrocalyx

Types of lesion in renal

tuberculosis.
 Treatment
• Anti-tubercular therapy
• Review urinary tract in 1st few weeks of therapy
because renal pelvis and ureter may stricture after
starting treatment
• Operative treatment:
– Conservative
– Aim to remove large infective foci, which are difficult to
treat with drugs, and correct obstruction caused by
fibrosis
– Optimum time = 6 – 12 weeks after the starting ATT
 Operative treatment
• Obstructed lower pole calyx – drain into upper
ureter
• Strictured renal pelvis – Pyeloplasty
– surgical reconstruction or revision of the renal pelvis
to drain and decompress the kidney; performed to
treat an uretero-pelvic junction obstruction
 Operative treatment
• Ureteric stenosis and shortening – Boari
operation or a bowel interposition (level and
extent of the fibrosis)
• If kidney has no function: Nephroureterectomy
TB OF BLADDER
• Secondary to renal TB

• Early TB commences around trigone

• In longstanding cases, there is marked fibrosis

and capacity of bladder is greatly reduced

• Responds rapidly to ATT

TB OF PROSTATE AND SEMINAL VESICLES
 Introduction
• Rare and associated with Renal TB
• 30% of cases, h/o pulmonary TB within 5 years
of the onset of genital TB
• On Examination:
– DRE:
• affected vesicle nodular pattern
• If prostate: nodules in one or both lateral lobes.
 C/F of Tuberculous prostatitis

• Urethral discharge
• Painful, sometimes blood stained, ejaculation
• Mild ache in the perineum
• Infertility
• Dysuria
• Abscess formation
 Investigations and treatment
• Radiography  displays areas of calcification
in prostate or seminal vesicles
• Bacteriological examination  positive culture
for tubercle bacilli

• Treatment:
– Anti tubercular therapy
– If prostate abscess drain transurethrally
Chronic epididymo-orchitis
 Chronic Disease
• Epididymitis: Inflammation confined to
epididymis
• Epididym-orchitis: Infection spreading to the
testis.
• Chronic tuberculous epididymo-orchitis
usually begins insidiously
• The infection is retrograde from a tuberculous
focus in the seminal vesicles
 Clinical features
• Firm discrete swelling of the lower pole of the
epididymis, with aches
• Disease progresses until the whole epididymis
is firm and craggy behind a normal-feeling
testis
• Seminal vesicle indurated and swollen
• Tuberculous cold abscess formation  later
discharges.
 Investigation
• In patients with chronic epididymo-orchitis 
Urine and semen for tubercle bacilli
• An intravenous urogram
• Chest radiograph
• USG
 Treatment
• Secondary tuberculous epididymitis may
resolve when the primary focus is treated
• Anti tuberculosis therapy
• If not resolve in 2 months epididymectomy or
orchidectomy is advisable
 References
• Bailey And Love Short Practice of Surgery, 25th
Ed.
THANK YOU!!