Genito-urinary tuberculosis - Experience with 52 urology inpatients
The original publication is available at http://www.samj.org.za
The current trend in South African health services is toward primary care. Pulmonary tuberculosis is well understood by the majority of primary care doctors and nurses, whereas genito-urinary tuberculosis may not be as easy to diagnose and treat. We reviewed our experience with this condition in 52 patients, who represented 0,74% of urology admissions between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involvement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting complaints were urinary frequency and haematuria, although flank and scrotal pain were also reported by a number of patients. Physical examination seldom helped to suggest the diagnosis. On microscopic examination and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform organism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosis drugs, but 58% also required some form of surgery; nephrectomy was the commonest operation. Ureteral strictures developed in over 50% of cases with renal involvement. We conclude that the diagnosis of genito-urinary tuberculosis is not simple, and that treatment must include regular follow-up at a specialist institution.
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