Nonhealing scrotal ulceration—an unusual manifestation of <scp>TB</scp> epididymo‐orchitis: case report and review of literature

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.

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Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

Jayarajah

Gunawardene

Willaraarachchi

et al. 2021

BMC Infect Dis

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Tuberculosis Testis In Middle-Aged Male As A Rare Case Of Genitourinary Tuberculosis: A Case Report

Surya,

Faadilah,

Indarjadi

et al. 2023

medicra

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Introduction: Testicular tuberculosis is a very rare type of urogenital TB. Case Presentation: A 36 year old man came to the emergency room because of pain in the right testicle accompanied by swelling and discharge. Orchiectomy on the dextra testis was continued with treatment using category 1 OAT for 9 months after the diagnosis was made using anatomic pathology examination. Discussion: The physical examination needs to be done carefully because most general practitioners consider testicular enlargement to be a malignancy. Urogenital tuberculosis requires 6 months of treatment and 9 months of treatment in patients with certain conditions. Conclusion: Prompt and precise diagnosis if testicular TB is necesssary to prevent infertility, the most common complication

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Challenges in the diagnosis of testicular infarction in the presence of prolonged epididymitis: Three cases report and literature review

Wang

Zhang

Fang

et al. 2020

XST

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INTRODUCTION: Testicular infarction is a rare complication of prolonged epididymitis and may be misdiagnosed as testicular torsion. In this study, we present three cases of testicular infarction and discuss their clinical characteristics, imaging features and clinical management. PATIENTS AND METHODS: Three adult males with prolonged epididymitis presented with chronic unilateral testicular pain, tenderness, and palpable swelling, including left varicocele in one case and hydrocele in the other two cases. Patient's symptoms were not relieved after antibiotic therapy. We analyzed the diagnosis, management, and outcome of these three cases of testicular infarction resulting from prolonged epididymitis. This includes the clinical characteristics, features of color doppler ultrasound imaging for diagnosis, and treatment strategy for testicular infarction from prolonged epididymitis. RESULTS: Complete blood count (CBC) indicated a small leukocytosis (10.6 ± 0.4 × 10 9 /L; normal arrange 3.5-9.5 WBC × 10 9 /L). Color doppler images demonstrated appropriate blood flow to areas of interest at patient's initial visit. At follow up visit several months later, the increased blood flow was detected at the edges of the involved testes with no blood flow to the center. The sizes of the involved testis (27 ± 4 ml) was significantly larger compared to the non affected side (17 ± 2 ml) (p < 0.05). Unilateral simple orchiectomy was performed on the involved testis in all three cases. Grossly, abscess cavities with caseous necrosis were found at the center of the testicle and epididymis in two patients. Histopathologic examination showed chronic inflammation with lymphocytic and macrophage infiltration of the involved testicle in two cases. The third case stained positive for acid fast bacteria. Left varicocele disappeared postoperatively in one patient. No pain, wound infection or other discomfort were noted 12 months after surgery.

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Nonhealing scrotal ulceration—an unusual manifestation of TB epididymo‐orchitis: case report and review of literature

Cited by 3 publications

References 6 publications

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

Tuberculosis Testis In Middle-Aged Male As A Rare Case Of Genitourinary Tuberculosis: A Case Report

Challenges in the diagnosis of testicular infarction in the presence of prolonged epididymitis: Three cases report and literature review

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