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      Clinical presentation and diagnostic approach in cases of genitourinary tuberculosis

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          Abstract

          Objective:

          We herein describe the various modes of presentation in genitourinary tuberculosis (GUTB) and a simple diagnostic approach to it.

          Materials and Methods:

          We made a literature search through Medline database and various other peer-reviewed online journals to study the various modes of presentation in GUTB. We reviewed over 100 articles published in the last 10 years (1998 -- 2007), which were tracked through the key words like GUTB and extrapulmonary tuberculosis.

          Results:

          GUTB has varied presentation and the most common way of presentation is in the form of irritative voiding symptoms, which are found in more than 50% of the patients. The usual frequency of organ involvement is: kidney, bladder, fallopian tube, and scrotum. The usual tests used to diagnose GUTB are the demonstration of mycobacterium in urine or body fluid and radiographic examination. Intravenous urography (IVU) has been considered to be one of the most useful tests for the anatomical as well as the functional details of kidneys and ureters. In cases of renal failure, MRI can be used. Newer examinations such as radiometric liquid culture systems (i.e., BACTEC ®, Becton Dickinson, USA) and polymerase chain reaction (PCR) give rapid results and are highly sensitive in the identification of mycobacterium.

          Conclusion:

          GUTB can involve any part of the genitourinary system and presentation may vary from vague urinary symptoms to chronic kidney disease. Newer tests like radiometric liquid culture systems and polymerase chain reaction give rapid results and carry high diagnostic value.

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          Most cited references30

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          Extrapulmonary tuberculosis.

          Extrapulmonary involvement can occur in isolation or along with a pulmonary focus as in the case of patients with disseminated tuberculosis (TB). The recent human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic has resulted in changing epidemiology and has once again brought extrapulmonary tuberculosis (EPTB) into focus. EPTB constitutes about 15 to 20 per cent of all cases of tuberculosis in immunocompetent patients and accounts for more than 50 per cent of the cases in HIV-positive individuals. Lymph nodes are the most common site of involvement followed by pleural effusion and virtually every site of the body can be affected. Since the clinical presentation of EPTB is atypical, tissue samples for the confirmation of diagnostic can sometimes be difficult to procure, and the conventional diagnostic methods have a poor yield, the diagnosis is often delayed. Availability of computerised tomographic scan, magnetic resonance imaging laparoscopy, endoscopy have tremendously helped in anatomical localisation of EPTB. The disease usually responds to standard antituberculosis drug treatment. Biopsy and/or surgery is required to procure tissue samples for diagnosis and for managing complications. Further research is required for evolving the most suitable treatment regimens, optimal duration of treatment and safety when used with highly active antiretroviral treatment (HAART).
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            Genitourinary manifestations of tuberculosis.

            By the 1980s, the availability of antituberculosis chemotherapy reduced the incidence and prevalence of tuberculosis. Changing patterns of population emigration and the development of large pools of immune-compromised individuals reversed the downward trend of tuberculosis. The incidence of genitourinary tuberculosis has remained constant. The manifestations of GU TB can be variable and cause a variety of clinical patterns that mimic other diseases. Adrenal insufficiency, renal disease, obstructive uropathy, and chronic cystitis are not uncommon with TB. The patient with TB may have genital disease that simulates STD or scrotal tumors. Infertility can be caused by GU tuberculosis. Awareness of environmental factors and patient history should alert the urologist to the wide array of clinical findings in the genitourinary system that can be caused by tuberculosis.
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              Genital tuberculosis in Indian infertility patients.

              To analyze the clinical and laparoscopic features of 40 infertile women with genital tuberculosis. This prospective clinical study was carried out at a tertiary care hospital from October 1, 2004, to August 30, 2006, with 150 infertile women in whom there was clinical suspicion of genital tuberculosis. All underwent diagnostic laparoscopy and biopsy for confirmation and other causes of infertility were excluded. Among the 40 infertile women affected with genital tuberculosis there were cases of primary (n=30) and secondary (n=10) infertility; pelvic pain (n=8); menorrhagia (n=9); oligomenorrhea (n=7); hypomenorrhea (n=8); and primary (n=2) and secondary (n=2) amenorrhea. There were histories of pulmonary (n=9) and abdominal tuberculosis (n=6), ectopic pregnancy (n=4), and antitubercular treatment (n=10) in 10. There were cases of positive Mantoux test results (n=2); endometrial aspiration showing tubercular endometritis (n=10); positive acid-fast bacillus culture results (n=1); and positive polymerase chain reaction results (n=9). Laparoscopic examination revealed abnormally dilated, tortuous, and blocked fallopian tubes (n=13); peritubal and periovarian adhesions (n=18); Fitz Hugh Curtis syndrome (n=15); omental adhesions (n=18); and bowel adhesions (n=15). Hysteroscopy revealed flimsy intrauterine adhesions (n=7). All patients were treated for tuberculosis and 13 were counseled for in-vitro fertilization and embryo transfer or adoption. Genital tuberculosis is common in India and a combination of clinical and laparoscopic diagnoses, along with endometrial histopathologic studies, acid-fast bacillus culture, and polymerase chain reaction assays provides the best available method for the diagnosis of genital tuberculosis in infertile women.
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                Author and article information

                Journal
                Indian J Urol
                IJU
                Indian Journal of Urology : IJU : Journal of the Urological Society of India
                Medknow Publications (India )
                0970-1591
                1998-3824
                Jul-Sep 2008
                : 24
                : 3
                : 401-405
                Affiliations
                Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rai Bareli Road, Lucknow - 226 014, UP, India
                Author notes
                For correspondence: Dr. Rakesh Kapoor, Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rai Bareli Road, Lucknow - 226 014, UP, India. E-mail: rkapoor@ 123456sgpgi.ac.in
                Article
                IJU-24-401
                10.4103/0970-1591.42626
                2684361
                19468477
                08c40e14-adfa-4dd8-8525-bf036297d089
                © Indian Journal of Urology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Urology
                genitourinary system,tuberculosis,gutb,diagnosis
                Urology
                genitourinary system, tuberculosis, gutb, diagnosis

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