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Etiology and management of genitourinary tuberculosis

Nature Reviews Urology volume 8, pages 678–688 (2011)Cite this article

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Abstract

Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary tuberculosis, with more than 90% of cases occurring in developing countries. Postmortem studies—from before anti-TB therapy was available—have provided insight into the prevalence and natural history of the disease. In GUTB, the kidneys are the most common sites of infection and are infected through hematogenous spread of the bacilli, which then spread through the renal and genital tract. Diagnosis of TB is often delayed owing to the nonspecific nature of its presentation; therefore, a high degree of suspicion should be exercised and a systematic approach should be taken during investigation. Appropriate culture samples should be obtained to tailor treatment. Standard treatment should be administered for 6 months; quadruple therapy for 2 months and dual therapy for 4 months. However, additional drugs and prolonged treatment are required if drug resistance occurs. Although the role of surgery in GUTB has decreased since the advent of anti-TB therapy, it can still have a role as an adjunct to drug treatment. Today, the challenges of GUTB and other forms of TB include increasing rates of drug-resistant cases and co-infection with HIV.

Key Points

  • Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary tuberculosis (EPTB), after lymph node tuberculosis (TB) in developing countries; nonspecific symptoms can delay diagnosis, resulting in disease progression and complications

  • The kidneys are the most common site of GUTB and are infected through hematogenous spread; from the kidneys, the bacilli can spread to the renal tract, prostate and epididymis

  • CT and intravenous urography can aid diagnosis—calcification, multiple strictures and fibrosis are suggestive features on imaging

  • GUTB is strongly associated with infertility in women, as the Fallopian tubes are affected in most cases, and rates of successful pregnancy remain low even after treatment

  • Standard drug treatment is for 6 months, but prolonged treatment with additional drugs is required if resistance occurs or the disease is severe

  • Drug resistance is a growing concern and culture samples should be obtained to identify drug sensitivity; PCR techniques show promise for identification of the organism and drug-resistance genes

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Figure 1: A postmortem specimen demonstrating caseation in the renal cortices of a patient affected by tuberculosis.
Figure 2: Intravenous urographic imaging of a patient with urological tuberculosis.

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C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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    Aula Abbara & Robert N. Davidson

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Abbara, A., Davidson, R. Etiology and management of genitourinary tuberculosis. Nat Rev Urol 8, 678–688 (2011). https://doi.org/10.1038/nrurol.2011.172

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