Background Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. Methods Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6–96). Results There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26–75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. Conclusions The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

An 89 year old female with diabetes mellitus, dyslipidemia, hypertension and ischemic heart disease admitted to orthopedic department following intra-capsular neck of femur fracture. While awaiting Austin Moore Hemiarthroplasty (AMH), she developed lower abdominal pain, fever, features of acute cystitis, hematuria and pneumaturia. Her urine culture was positive for Escherichia coli (E. coli) and blood culture for gram negative bacilli. Further evaluation with abdominal X-ray (Figure 1) and computed tomography (CT) (Figure 2) showed evidence of emphysematous cystitis (EC). Her urosepsis was treated with intravenous (IV) Meropenem 500mg eight hourly for 14 days. She recovered from sepsis and subsequently underwent AMH.

An 89 year old female with diabetes mellitus, dyslipidemia, hypertension and ischemic heart disease admitted to orthopedic department following intra-capsular neck of femur fracture. While awaiting Austin Moore Hemiarthroplasty (AMH), she developed lower abdominal pain, fever, features of acute cystitis, hematuria and pneumaturia. Her urine culture was positive for Escherichia coli (E. coli) and blood culture for gram negative bacilli. Further evaluation with abdominal X-ray (Figure 1) and Computed Tomography (CT) (Figure 2) showed evidence of Emphysematous Cystitis (EC). Her urosepsis was treated with Intravenous (IV) Meropenem 500 mg eight hourly for 14 days. She recovered from sepsis and subsequently underwent AMH.

IntroductionForeign bodies in the urinary tract may present in various ways. These require a wide range of interventions for retrieval. In this study, we describe our experience in managing foreign bodies in the urinary tract with emphasis on clinical presentation, mechanism of insertion, investigation and treatment of these patients from a South Asian country. MethodsA retrospective analysis of 30 foreign bodies treated by a single urological surgeon in two teaching hospitals in Sri Lanka over 20 years was performed. Data were retrieved from clinical records and follow-up visits focussing on clinical presentation, nature of foreign bodies, mechanism of insertion, investigations, management and complications. ResultsThe majority were males (73.3%, n=22) with a median age of 34 years (range:14-72). The majority were self-inserted (n=14) or iatrogenic (n=10). X-rays and ultrasound scans were useful in the majority to clinch the diagnosis. The majority were retrieved endoscopically through minimally invasive approaches. Open surgeries were needed for a patient with a large bladder stone associated with a metal chain and retrieval of a retained swab. Common complications associated with foreign bodies included infections (n=9), calcification/ stone formation (n=9) and acute urinary retention (n=4). Among deliberate selfinsertions, two had a low intelligent quotient and the majority had no underlying psychiatric condition needing intervention. ConclusionsSimple investigations such as X-ray and ultrasound scans are sufficient to locate and plan interventions in the majority. Minimally invasive approaches are successful in most. The