Nationwide survey of urogenital tuberculosis in Japan

Abstract

Objectives: To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan. Methods: A questionnaire was sent to the urological departments of 1203 Japanese hospitals. Clinical data was reviewed retrospectively; no time range was specified. Results: Of the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9). Conclusions: Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.Key words: nationwide survey, urinary tract infection, urogenital tuberculosis. IntroductionThere are various symptoms of TB, some of which indicate a delayed allergic reaction to Mycobacterium tuberculosis. As tuberculosis is primarily a sinopulmonary infection, the lungs are most commonly affected, but other infection sites are also possible. Tuberculosis is thus classified into two categories: PTB and EPTB.1 Most EPTB, including UTB, develop after PTB. In Japan, TB incidence has decreased from 698.4 patients per 100 000 people per year in 1951 to 19.0 patients per 100 000 people per year in 2009. 2 In 2008, just 121 urinary tract TB patients and 34 genital TB patients were reported.3 Therefore, Japanese urologists seldom encounter UTB patients in common practice. However, UTB can occur several decades after the initial TB infection. 4 The Tuberculosis Surveillance Center, which is part of the Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association, provides epidemiological data on TB incidence in Japan, the number of EPTB patients and modes of treatment of all EPTB (including UTB).5 However, there is generally very little information about UTB patients. The present study examined the following: the number of recent UTB patients, the social and medical background of UTB patients, the role of urinary examination in UTB diagnosis, the incidence of drug-resistant UTB, the causes of doctor's delay, and UTB treatment options. The academic committee of the Japanese Urological Association approved the study. MethodsA questionnaire was sent to 1203 Japanese hospitals with urological departments in April 2007. Clinical data was reviewed retrospectively; no time range was specified. The questionnaire collected information in the following seven categories: (i) patient background; (ii) clinical examinations; (iii) grounds for diagnosis; (iv) patient and doctor delay; (v) mode of therapy; (vi) prognosis; and (vii) infection control. In the "patient background" category, we collected the following information: patient's sex, age at diagnosis, mode of symptoms, history of tuberculosis (lung, pleura, lymph nodes, bone and others); underlying disease (diabetes mellitus, end stage renal disease, HIV infection and others), socioeconomic backgrounds (coming from other coun...

Update on urogenital tuberculosis in Southern Tunisia: a review of a 26-year period

“…In Japan, 31% of UGTB patients had a history of TB. 16 Previous research showed that UGTB occurred in 2 to 20% of pulmonary TB patients, worldwide. 16 Besides, 28% of patients with pulmonary TB had prostate TB, 3 which was higher than our results.…”

“…16 Previous research showed that UGTB occurred in 2 to 20% of pulmonary TB patients, worldwide. 16 Besides, 28% of patients with pulmonary TB had prostate TB, 3 which was higher than our results. This might be explained by the misdiagnosis and the underestimation of UGTB cases among patients with pulmonary TB, which took all the attention.…”

Review of 175 Cases of Tuberculosis Infections Affecting the Urogenital System

“…The even higher proportion of males in DTU (80%) may be related to risk factors for the disease being more prevalent in males, and the findings were in line with those previously reported by other authors reporting a large majority of males between patients diagnosed with both UGTB and DTU. 5 , 10 , 13 Interestingly, the presence of known risk factors for mycobacterial infection (injected drug usage, HIV infection, active chemotherapy, or other immunosuppressant medication) was common in DTU but had a low prevalence among patients with UGTB. 3 Previous reports are rare, have patients more than 15 years, and are mainly from non-developed countries where HIV infection is more prevalent.…”

“…The diagnosis of UGTB has been reported as difficult to obtain 3 , 13 and should include a combination of at least urine sediment analysis, smear and culture for acid-fast bacilli, and PCR for MTc in urine, with histology being obtained only when adequate or needed. Overall, in our series, the proportions of positive tests were similar to previous studies, with no single test (among those who allow TB diagnosis) having a sensitivity > 85%.…”

Editorial Comment to Nationwide survey of urogenital tuberculosis in Japan

“…Therefore, the article by Nakane et al . is highly relevant to the urological community in Japan and worldwide to highlight that although rare, UGT is alive and must be known and remembered . In the present article, 355 UGT cases are described showing the features of the disease with data according to other UGT patients series …”