Genitourinary tuberculosis in pediatric surgical practice

doi:10.1016/S0022-3468(97)90302-X

Journal of Pediatric Surgery

Volume 32, Issue 9, September 1997, Pages 1283-1286

https://doi.org/10.1016/S0022-3468(97)90302-X Get rights and content

Abstract

Background: Genitourinary tuberculosis (GUTB) has been reported to account for 20% to 73% of all cases of extrapul-monary tuberculosis in the general population but is much rarer in children. GUTB is a form of secondary tuberculosis with vague symptoms. Surgical intervention is required in a minority of cases.

Methods: Nine cases of genitourinary tuberculosis (GUTB) were diagnosed and treated from 1988 to 1995. The age of the patients ranged from 5 to 12 years. There were five boys and four girls. Presenting features were diverse and included gross hematuria in 44% of cases and epididymoorchitis in 22% of cases. Rarer presenting features included acute renal failure, staghorn calculus, and pyonephrosis. Associated or past history of tuberculosis was present in three patients. Conclusive diagnosis was made on the basis of isolation of mycobacterium tuberculosis, histopathology, or cystoscopy in eight patients, whereas one patient was given a therapeutic trial based on clinical manifestations.

Results: Response to antitubercular drug therapy was gratifying. Excisional surgery in the form of nephrectomy was needed in one patient, whereas another underwent bilateral ureteric replacement with ileal loops for multiple ureteric strictures.

Conclusions: The wide variety of presenting features and pathological lesions that result from GUTB are emphasized. The diagnosis of GUTB must be suspected in patients who present with hematuria (gross or otherwise), epididymoorchitis, and patients with long segment or multiple ureteric strictures. In view of the anticipated resurgence in tuberculosis caused by the prevalence of aquired immunodeficiency syndrome the pediatric urologist must be aware of the pathophysiology and clinical spectrum of this disease.

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Cited by (53)

Presentation, management and outcomes of pediatric urogenital tuberculosis: 20 years’ experience from a tertiary center
2021, Journal of Pediatric Urology
Urogenital tuberculosis (UGTB) has traditionally being a diagnosis of adulthood and is supposed to be rare in children, as it is believed that the symptoms of renal tuberculosis do not appear for 10 or more years after the primary infection. While this may be true in developed countries, where childhood pulmonary tuberculosis is a rarity nowadays. In developing countries, childhood pulmonary tuberculosis is still a major issue and hence, UGTB is not an uncommon diagnosis in younger children and adolescents in these countries. Considering this dearth of data on childhood UGTB, we retrospectively evaluated our series of children with this disease, with special emphasis on the role of surgery.
To analyze the clinical presentation, management strategies and outcomes of pediatric UGTB managed in a tertiary care center.
Case records of children and adolescents ≤18 years diagnosed with UGTB during the period July 1998 to June 2018 at our center were reviewed. Clinical features, organ involvement, investigations, treatment and outcome of therapy were studied.
There were 41 children and adolescents (M: F = 22:19) identified, with a mean age of 14.8 ± 3.9 years who fulfilled the inclusion criteria. The most common presentation was flank pain and irritative storage symptoms. Mycobacterium tuberculosis was identified on urinary examination in only 17 (41.5%) cases. Six patients were lost to follow up after initial diagnosis. A total of 45 procedures (35 primary and 10 secondary) were performed in 35 children. Initial diversion in the form of PCN and DJS were done in 11 and 12 patients respectively, of which 8 were managed with stenting alone. Surgical management was done mostly in the form of nephrectomy (15), nephrectomy along with reconstruction (5) and reconstruction only (6). On univariate analysis, factors associated with nephrectomy were poor initial function and nephrostomy as initial diversion. Overall median follow-up was 25 (IQR 15.5–74.25) months. During follow up, chronic renal failure developed in nearly 53.8% of patients who underwent major reconstruction.
Urogenital tuberculosis presents with a wide spectrum of clinical features and pathological lesions. Diagnosis is often delayed because of late presentation and many children present with cicatrization sequelae. Antitubercular drug therapy and judicious application of minimally invasive diversions and surgery (both ablative and reconstructive) achieve satisfactory results in the majority of cases. Children undergoing major surgical reconstruction in particular need to be followed up rigorously and counselled about possibility of development of renal failure.
Gross hematuria: A rare presentation of disseminated tuberculosis
2020, Indian Journal of Tuberculosis
Citation Excerpt :
However various factors such as malnutrition, stress, immune deficiency, etc. may result in reactivation.4 Lattimer et al in their case series found the earliest age of renal tuberculosis being 2–3 years whereas the cases reported by Chattopadhyay et al belong to 5–12 years of age.5,6 Alexander and Carol in 2009 in their case report described renal and miliary tuberculosis in a 5-month-old infant.7
Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria.
12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.
Utility of GeneXpert in the diagnosis, reliance on urine microscopy and clinical characteristics of genitourinary tuberculosis at a tertiary care hospital
2018, Indian Journal of Medical Microbiology
Background: One-third of the world’s population is infected with tuberculosis (TB) with new infection occurring every second. In humans, TB is primarily caused by Mycobacterium tuberculosis (MTB). Genitourinary TB (GUTB) is still a major health problem in many developing countries including India and had been declared by the World Health Organisation as ‘public health emergency’ in 1993. Materials and Methods: This is a prospective study conducted at a tertiary care hospital involving 46 patients who presented with clinical feature suggestive of GUTB – urine specimens of these 46 patients were analysed for acid–fast bacilli (AFB), AFB culture, GeneXpert, and other relevant investigations were done to reach the diagnosis. Majority of patients were female (65.25%). This is especially relevant to rural and low socioeconomic areas in developing countries where women’s health is worse than men’s (in terms of nutrition); women’s risk of disease may be increased. Most of our patients were above 30 years of age and exhibited nonspecific symptoms such as dysuria, haematuria and frequency. All patients were put on antitubercular drugs and followed as per the guidelines. Conclusion: The sample size in the present study is small to arrive at a brisk inference, but it may safely be postulated that yield of detection for GeneXpert may be improved using multiple sampling, especially the early morning ones. It is also pertinent to mention here that GeneXpert may not be able to pick up mutant genomes.
Clinical presentation and epidemiology of female genital tuberculosis in eastern Sudan
2012, International Journal of Gynecology and Obstetrics
Citation Excerpt :
By contrast, the present study demonstrated chronic pelvic pain as the predominant clinical feature (87%) of FGTB followed by pelvic mass, cyst and/or abscess (68%). In total, 8%–15% of all patients with pulmonary TB are suspected to be at risk of developing genitourinary TB, with active genital disease presenting 5–25 years after the primary infection [14]. This fact might explain the wide age range of women diagnosed with FGTB in the present study.
To describe the epidemiology and clinical presentation of female genital tuberculosis (FGTB) among women in eastern Sudan.
A cross-sectional survey was conducted at Kassala Maternity Hospital, Sudan, from January 1 to December 31, 2010.
Of the 2778 women presenting with various gynecologic symptoms, 44 suspected cases of FGTB were identified. Granulomatous tissue reactions were observed in 25 of the suspected FGTB cases, yielding an incidence of 0.9%. The majority (20/25; 80%) of these patients presented with chronic pelvic and lower abdominal pain; however, 68.0% (17/25) presented with pelvic mass, cyst and/or abscess; 48.0% (12/25) had dyspareunia; 40.0% (10/25) were infertile; 28% (7/25) had menstrual dysfunction; 20.0% (5/25) had dysmenorrhea; and 4.0% (1/25) experienced postmenopausal bleeding. Body mass index, residence, and educational level were significantly different between women diagnosed with FGTB and those where FGTB was excluded (P values = 0.02, 0.03, and 0.01, respectively). However, no significant differences were found in age and Bacillus Calmette-Guérin vaccination status.
Clinical suspicion may facilitate and improve the detection of FGTB, with chronic pelvic pain identified as the predominant clinical presentation among women in eastern Sudan.
Isolated tuberculous epididymitis presenting as a painless scrotal tumor
2012, Journal of the Chinese Medical Association
Citation Excerpt :
Despite advances in anti-mycobacterial therapy and strict implementation of well-known TB control measures, the prevalence and incidence of TB remains high worldwide. Epididymal TB, which accounts for about 20% of genitourinary tuberculosis,6 is believed to result from a retrograde spread of prostate TB, which is usually secondary to a renal TB.7 ITE, which is defined as TB epididymitis without clinical and laboratory evidence of renal involvement,4 is a rare and hard-to-diagnose disease entity.
Genitourinary tuberculosis, the second most common extrapulmonary tuberculosis (TB), is very difficult to diagnose unless one maintains a high index of suspicion. Isolated tuberculous epididymitis (ITE), defined as tuberculous epididymitis without clinical evidence of either renal or prostate involvement, is a rare entity among genitourinary tuberculosis. When diagnosed correctly, ITE can be cured with anti-TB medications. However, patients with poor response to medical treatment may require surgery. Here, we report a 20-year-old man who presented with a slow-growing painless scrotal tumor for 2 months, with the initial workup suspicious for a right paratesticular tumor. Surgical resection of the tumor was therefore scheduled. However, severe pain and redness over the patient's right hemi-scrotum were noted on the day of surgery. A repeat scrotal ultrasound was performed that revealed findings suggesting a chronic inflammatory process rather than a malignancy. Frozen section of the lesion confirmed the ultrasonographic findings, and the pathology established the diagnosis of ITE. The patient remained on anti-TB therapy postoperatively for 6 months and had an excellent outcome.
The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report
2024, BMC Urology

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