Sriram Krishnamoorthy1, Velmurugan Palaniyandi2, Natarajan Kumaresan1, Sivasankar Govindaraju3, Jayaganesh Rajasekaran4, Ilangovan Murugappan3, Venkat Ramanan1, Muthulatha Navaneetha Krishnan5. 1. Professor, Department of Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. 2. Assistant Professor, Department of Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. 3. Professor, Department of Urology, Government Kilpauk Medical College, Chennai, Tamil Nadu, India. 4. Senior Consultant, Department of Urology, Government Royapettah Hospital, Chennai, Tamil Nadu, India. 5. Professor, Department of Urology, Madras Medical College, Chennai, Tamil Nadu, India.
Abstract
INTRODUCTION: Genito Urinary Tuberculosis (GUTB) is a widespread disease seen in urology practice. The true incidence and prevalence of GUTB is difficult to estimate because a large number of patients remain asymptomatic. AIM: To recognize typical and atypical clinical and radiological features of tuberculosis and to emphasize the need for diagnosing GUTB early. MATERIALS AND METHODS: This was a retrospective study conducted in 110 cases of GUTB diagnosed and treated in two teaching institutions over a period of three years, from July 2002 to June 2005. A detailed history, thorough clinical examination, urine examination, culture for tubercle bacillus, imaging studies, cystoscopy and histological and serological examination were done to arrive at a diagnosis. RESULTS: Fifty six patients (51%) were in the age group of 21-40 years. The male: female ratio was 1.4: 1. Loin pain was the most common symptom observed in 27% of the patients. Intravenous Urogram (IVU) revealed non-visulalised kidney in 25 patients (23%), hydronephrosis or hydrouretero nephrosis in 34 patients (31%) and distortion, cavitation or scarring of the calyces in 16 patients (14.5%). Five of them had thimble bladder. In 14 patients, IVU appeared normal. About 28 patients (25%) were treated conservatively with anti tuberculosis therapy. Twenty one of them (19%) underwent Nephrectomy and 10 patients had reconstructive procedures. CONCLUSION: A peculiarity of most of our patients was a late presentation with advanced disease. Most patients were asymptomatic or ignorant. Slow but continuous infection causes a destruction of renal parenchyma and the healing process leads to renal parenchymal loss. If identified early and treated appropriately, GUTB is a curable condition.
INTRODUCTION: Genito Urinary Tuberculosis (GUTB) is a widespread disease seen in urology practice. The true incidence and prevalence of GUTB is difficult to estimate because a large number of patients remain asymptomatic. AIM: To recognize typical and atypical clinical and radiological features of tuberculosis and to emphasize the need for diagnosing GUTB early. MATERIALS AND METHODS: This was a retrospective study conducted in 110 cases of GUTB diagnosed and treated in two teaching institutions over a period of three years, from July 2002 to June 2005. A detailed history, thorough clinical examination, urine examination, culture for tubercle bacillus, imaging studies, cystoscopy and histological and serological examination were done to arrive at a diagnosis. RESULTS: Fifty six patients (51%) were in the age group of 21-40 years. The male: female ratio was 1.4: 1. Loin pain was the most common symptom observed in 27% of the patients. Intravenous Urogram (IVU) revealed non-visulalised kidney in 25 patients (23%), hydronephrosis or hydrouretero nephrosis in 34 patients (31%) and distortion, cavitation or scarring of the calyces in 16 patients (14.5%). Five of them had thimble bladder. In 14 patients, IVU appeared normal. About 28 patients (25%) were treated conservatively with anti tuberculosis therapy. Twenty one of them (19%) underwent Nephrectomy and 10 patients had reconstructive procedures. CONCLUSION: A peculiarity of most of our patients was a late presentation with advanced disease. Most patients were asymptomatic or ignorant. Slow but continuous infection causes a destruction of renal parenchyma and the healing process leads to renal parenchymal loss. If identified early and treated appropriately, GUTB is a curable condition.
Entities:
Keywords:
Acid fast bacilli; Hydronephrosis; Nephrectomy; Tubercle bacillus; Tuberculoma