Tuberculosis of the urinary tract and male genitalia - A diagnostic challenge for the family practitioner

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dc.contributor.authorZarrabi A.D.
dc.contributor.authorHeyns C.F.
dc.date.accessioned2011-05-15T16:17:57Z
dc.date.available2011-05-15T16:17:57Z
dc.date.issued2009
dc.description.abstractTuberculosis (TB) of the urinary tract and male genital system can be very difficult to diagnose unless a high index of suspicion is maintained. The most common presenting features of urogenital tuberculosis (UGTB) are lower urinary tract symptoms (LUTS), haematuria, recurrent urinary tract infection (UTI) by Gram-negative organisms, flank pain, and scrotal swelling. The classically described sterile pyuria should arouse suspicion of UGTB, but in about a third of patients a Gram-negative organism is cultured from the urine, so recurrent bacterial UTI should always be further investigated. Intravenous pyelography (IVP) remains the best imaging study available to screen for UGTB, but ultrasound and computerised tomography (CT) imaging can also be useful. The diagnosis of UGTB is most often confirmed with urine culture: at least 3-5 early morning urine specimens must be submitted and the results may take 4-6 weeks. Histological diagnosis on bladder or testicular biopsies can be made if granulomatous inflammation and Ziehl-Neelsen (ZN) positive organisms are seen. HIV-positive individuals are at greater risk of acquiring TB, and patients with confirmed or suspected UGTB should always be tested for HIV infection. Medical treatment of UGTB requires combination anti-TB drug therapy for at least six months. Patients should be followed up closely with monthly imaging because upper tract obstruction may develop due to fibrosis while on therapy. Surgery for UGTB can be extirpative (e.g. nephrectomy) or reconstructive (e.g. enterocystoplasty, to enlarge a fibrotic bladder). The outcome of UGTB is good if the diagnosis is made early, but delayed diagnosis may lead to loss of renal function. © SAAFP.
dc.description.versionReview
dc.identifier.citationSouth African Family Practice
dc.identifier.citation51
dc.identifier.citation5
dc.identifier.issn1726426X
dc.identifier.urihttp://hdl.handle.net/10019.1/14441
dc.subjectamikacin
dc.subjectcapreomycin
dc.subjectethambutol
dc.subjectisoniazid
dc.subjectkanamycin
dc.subjectlevofloxacin
dc.subjectmoxifloxacin
dc.subjectofloxacin
dc.subjectpyrazinamide
dc.subjectquinoline derived antiinfective agent
dc.subjectrifampicin
dc.subjectstreptomycin
dc.subjecttuberculostatic agent
dc.subjectbladder biopsy
dc.subjectbladder reconstruction
dc.subjectcomputer assisted tomography
dc.subjectdrug dose reduction
dc.subjectflank pain
dc.subjectgeneral practitioner
dc.subjectGram negative bacterium
dc.subjecthematuria
dc.subjecthuman
dc.subjectintravenous pyelography
dc.subjectintravenous urography
dc.subjectkidney function
dc.subjectmale genital tract infection
dc.subjectnephrectomy
dc.subjectpyuria
dc.subjectreview
dc.subjectscrotal swelling
dc.subjecttestis biopsy
dc.subjecturinalysis
dc.subjecturinary tract infection
dc.subjecturine culture
dc.subjecturogenital tuberculosis
dc.titleTuberculosis of the urinary tract and male genitalia - A diagnostic challenge for the family practitioner
dc.typeReview
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