An Analysis of the Clinical Presentation , Diagnosis , Management Options and Outcome of the Patients With Genito - Urinary Tuberculosis

Abstract

AIMS AND OBJECTIVES:To analyze various clinical presentations and the treatment options in the management of the patients with genitourinary tuberculosis and to evaluate the role of urinary PCR in the detection of mycobacterium tuberculosis in patients with a clinical suspicion of genito urinary tuberculosis and to compare its sensitivity with urine for AFB smear, urine for myc. tuberculosis culture and bladder biopsy. MATERIALS AND METHODS: This is a retrospective and prospective study of patients with a diagnosis of genitourinary tuberculosis who underwent treatment in Gandhi General Hospital between January 2009 to December 2014. 62 patients with a diagnosis of genitourinary tuberculosis who underwent treatment were taken initially into the study. Five patients lost follow up after initial visits. These patients were excluded from the study. The remaining 57 patients were managed. RESULTS: Irritative voiding symptoms (Frequency / Urgency / Dysuria) were the most common symptoms. Gross hematuria seen in 22(38.5%) patients and microscopic hematuria seen in 53% of patients. Urine for AFB attaining was positive in 16(31.3%) patients, urine for MTb culture was positive in 21(41.1%) patients and pus for MTb culture was positive in 4 of 7 cases. Urinary PCR to identify the mycobacterial DNA was performed in 37 patients and was positive in 25(67.5%) of 37 clinically suspected cases. The urinary PCR was falsely positive in 1(2.7%) and falsely negative in 12(32.5%) patients. Kidney was involved in 26(45.6%) cases and ureter in 24(42.1%), and bladder in 28(49.1%) cases. Overall surgical intervention was done in 36 patients. All patients received 4 to 8 weeks ATT before they were taken up for surgical intervention. In 24 patients who presented with ureteric strictures, 7 patients had nonfunctioning kidneys and subsequently underwent nephroureterectomy, 8 patients had subnormal renal function in whom DJ stenting was done in 6 patients and PCN was done in 2 patients where DJ stenting was not possible. CONCLUSION: The manifestations of genitourinary tuberculosis can be variable and cause a variety of clinical patterns that mimic other diseases. Most of the cases present with advanced disease and high index of suspicion is necessary for the early diagnosis of genitourinary tuberculosis. PCR presents an advance in the diagnosis of GUTB. Urinary PCR is the most sensitive indicator of all microbiological tests and in combination with radiological abnormalities provides much faster diagnosis of genitourinary tuberculosis. However, it is an elaborate test that requires meticulous care to avoid false-positive and false-negative results. Multidrug chemotherapy combined with judicious surgery as and when indicated is the ideal treatment.