Diagnosis and management of genitourinary tuberculosis: an institutional experience

Introduction: Genito-urinary Tuberculosis (GUTB) has been found to occur in 15-20% of the patients who have ever contracted Pulmonary Tuberculosis in their lifetime. 90% of GUTB cases are seen in developing countries. GUTB is the second most common extra-pulmonary Tuberculosis, lymph node TB being the most common. GUTB continues to be a significant clinical problem because of its non specific clinical presentation and variable radiological appearance. Patients with advanced urogenital TB also present with very few symptoms, thus making it more difficult to anticipate and manage. Material and Methods: Our study population comprised of 75 patients who were diagnosed with GUTB, and admitted in our tertiary care hospital from Sept 2018 to Feb 2021. A thorough clinical evaluation was supplemented by microbiological evaluation such as urine evaluation for Acid Fast Bacilli, urine culture and sensitivity, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and radiological evaluation of kidneys, ureters and bladder with the help of ultrasonography, Intravenous Pyelography, Computed Tomography scans and Magnetic Resonance Urography. Results: Most patients with GUTB were found to be in the 3rd and 4th decades of life, with mean age being 38.6 years. Amongst the patients evaluated in our study, a male sex predominance was found to be there with 48 males and 27 females. Among symptoms, most common symptoms were storage symptoms such as increased frequency of micturition seen in 80%cases, urgency in 77%cases, dysuria in 73% cases and so on. CT Urogram changes were seen in 86% and IVP changes were noted in approximately 70% patients. In this report, we have compiled our collection of exclusive images obtained from our study population, that helped to build a conclusive diagnosis of GUTB in our patients. Conclusion: Genitourinary tuberculosis remains a major health problem in developing countries. GUTB can involve any part of the genitourinary system. Diagnosis is usually delayed due to nonspecific symptoms and variable radiological appearance. Early changes can be seen on intravenous pyelogram and computed tomography. Immediate stenting and medical management is the mainstay of GUTB treatment. Long term follow up is required after reconstructive surgeries.