Genitourinary tuberculosis contributes to 10-14% of extrapulmonary tuberculosis and is a major health problem in India. Prostate tuberculosis is uncommon and is usually found incidentally following transurethral resection. The most common mode of involvement is hematogenous, though descending infection and direct intracanalicular extension is known. Predisposing factors include prior tubercular infection, immuno-compromised status, previous BCG therapy. The presentation is diffuse caseating epitheloid cell granulomas, which can be confirmed by prostate biopsy. Urine PCR has good sensitivity (95.5%) and specificity ( 98.12%) in diagnosis. Imaging techniques like TRUS and CT/MRI also allow good visualization of the lesion and its extension. Urethral tuberculosis is very rare and is usually secondary to upper tract or genital tuberculosis. The presentation may be acute urethritis or chronic stricture or fistulae. The treatment of choice is chemotherapy with 3-4 anti tubercular drugs for initial 6-12 weeks and later 2 drugs for additional 3-6 months. Surgery is usually reserved for cases where chemotherapy fails and is done after 4-6 weeks of ATT. With a high index of suspicion it may be possible to diagnose a larger number of cases of prostatic and urethral tuberculosis especially in this country where tuberculosis is almost endemic.
Pituitary abscess is a rare condition occurring in various age groups. Only about a hundred cases have been reported in the literature. We describe six cases that constitute 0.6% of all the pituitary lesions operated at this centre in the last 10 years. All the patients presented with visual symptoms, though systemic features of infection were present in only two cases. The abscess was seen in association with adenoma in two cases and Rathke's cleft cyst in one. One patient developed an abscess following surgery for pituitary adenoma. The offending organisms was fungal in two cases, mycobacterium in one, bacterial in one and two cultures were sterile. Preoperative diagnosis is difficult and a high degree of suspicion in ring enhancing lesions of the sella is required.
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