Skip to main content
SpringerLink
Log in

Urogenitaltuberkulose in Deutschland

Diagnose und Behandlung

Genitourinary tuberculosis in Germany

Diagnosis and treatment

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die Urogenitaltuberkulose (UGT) ist eine postprimäre Exazerbationstuberkulose und wird von Erregern des Mycobacterium-tuberculosis-Komplexes verursacht. Hinweise auf das Vorliegen einer UGT können Anamnese, klinische Symptomatik, eine abakterielle Pyurie und die bildgebende Diagnostik geben. Ein positiver kultureller Mykobakteriennachweis (Eigelbnährböden) und/oder der Nachweis tuberkulosespezifischer Gewebeveränderungen in Kombination mit einer Polymerasekettenreaktion (PCR) sichern die Diagnose der UGT. Die medikamentöse Therapie der UGT wird in einer Intensivphase mit 3 oder 4 Medikamenten täglich über 2 Monate begonnen und danach in einer Kontinuitätsphase mit 2 Antituberkulotika für mindestens 4 Monate fortgesetzt. Die zusätzliche operative Therapie der UGT ist nur bei Komplikationen und/oder Folgeerscheinungen im klinischen Verlauf indiziert. Nach der Therapie der UGT wird eine Nachsorge über mindestens 5 Jahre empfohlen. Trotz geringer Neuerkrankungsrate in Deutschland ist es weiter notwendig, die wissenschaftlichen Kenntnisse zur Diagnostik und Therapie der UGT zu erhalten und zu vertiefen.

Abstract

Genitourinary tuberculosis (GUTB) usually results from the reactivation of old, dormant tuberculous diseases by pathogens of the Mycobacterium tuberculosis complex. The diagnosis of tuberculosis of the urinary tract is based on the case history, the finding of pyuria in the absence of infection as judged by culture on routine media and by radiological imaging. A positive yellow egg culture and/or histological analysis of biopsy specimens possibly combined with the polymerase chain reaction (PCR) is still required in most patients to establish a definitive diagnosis of GUTB. Antituberculous drug treatment is based on an initial 2 month intensive phase with three or four drugs daily followed by a 4 month continuation phase with only two drugs. Surgery as a treatment option in GUTB might be indicated in complicated urinary tuberculosis. After antituberculous treatment of GUTB a follow-up surveillance over 5 years is recommended. Although the incidence of GUTB in Germany is relatively low, it is still necessary to impart and deepen scientific knowledge of the diagnosis and therapy of GUTB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Barišić Z, Vralović-Carević N, Milostićk et al (2003) Tuberculous orchiepididymitis diagnosed by nucleic acid amplification test: a case report. Intern Urol Nephrol 35:203–205

    Article  Google Scholar 

  2. Brönnecke M, Hauer B, Castell S et al (2010) Niedriger Kenntnisstand zur Tuberkulose bei hausärztlich tätigen Ärztinnen und Ärzten. In: Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (Hrsg) 33. Informationsbericht. Berlin, S 40–42

  3. Carl P, Stark L (1997) Indications for surgical management of genitourinary tuberculosis. World J Surg 21:505–510

    Article  PubMed  CAS  Google Scholar 

  4. Cek M, Lenk S, Naber KG et al (2005) EAU guidelines for the management of genitourinary tuberculosis. Eur Urol 48:353–362

    Article  PubMed  Google Scholar 

  5. Engin G, Acunas B, Acunas G et al (2000) Imaging of extrapulmonary tuberculosis. Radiographics 20:471–488

    PubMed  CAS  Google Scholar 

  6. European Centre for Disease Prevention and Control (ECDC) (2009) Tuberculosis surveillance in Europe 2009. http://www.ecdc.europa.eu/en/publications/Publications/1103_TB_SUR_2009.pdf

  7. Figueiredo AA, Lucon AM, Junior RF, Srougi M (2008) Epidemiology of urogenital tuberculosis worldwide. Int J Urol 15:827–832

    Article  PubMed  Google Scholar 

  8. Forßbohn M, Zwahlen M, Loddenkemper R, Rieder HL (2008) Demographic characteristics of patients with extrapulmonary tuberculois in Germany. Eur Respir J 31:99–105

    Article  Google Scholar 

  9. Deutsches Zentralkommitee zur Bekämpfung der Tuberkulose (DZK) (2010) 33. Informationsbericht. Berlin

  10. Gow JG (1997) Genitourinary tuberculosis: a study of short course regimes. J Urol 115:707–711

    Google Scholar 

  11. Harisinghani MG, McLaud TC, Shepard JA et al (2000) Tuberculosis from head to toe. Radiographics 20:449–470

    PubMed  CAS  Google Scholar 

  12. Harries D (2008) Robert Koch and the discovery of the tubercle bacillus: the challenge of HIV and tuberculosis 125 years later. Int J Tuberc Lung Dis 12:241–249

    PubMed  CAS  Google Scholar 

  13. Hemal AK, Gupta NP, Rajeev TP et al (2000) Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology 56:570–574

    Article  PubMed  CAS  Google Scholar 

  14. Hillemann D, Richter E, Rüsch-Gerdes S (2006) Use of BACTEC Mycobacteria Growth Indicator Typ 960 automated system for recovery of mycobacteria from 9558 extrapulmonary specimens, including urine samples. J Clin Microbiol 44:4014–4017

    Article  PubMed  Google Scholar 

  15. Hillemann D, Rüsch-Gerdes S, Böhme C, Richter E (2011) Rapid molecular detection of extrapulmonary tuberculosis by the automated GenXpert MTB/RIF system. J Clin Microbiol 49:1202–1205

    Article  PubMed  CAS  Google Scholar 

  16. Kim HH, Lee KS, Park K, Ahn H (2000) Laparoscopic nephrectomy for nonfunctioning tuberculous kidney. J Endurol 14:433–437

    Article  CAS  Google Scholar 

  17. Kulchavenya E, Kim C-S (2010) Male genital tuberculosis. In: Naber KG, Schaeffer JA, Heyns CF et al (Eds) Urogenital Infections, European Association of Urology/International Consultation on Urologic Diseases, Edition 2010. S 877–891

  18. Lenk S, Schröder J (2001) Genitourinary tuberculosis. Curr Opin Urol 11:93–96

    Article  PubMed  CAS  Google Scholar 

  19. Lenk S, Yasuda M (2010) Urinary tuberculosis. In: Naber KG, Schaeffer JA, Heyns CF et al (Eds) Urogenital Infections, European Association of Urology/International Consultation on Urologic Diseases, Edition 2010. S 864–876

  20. Medlar EM, Spain DM, Holliday RW (1949) Post-mortem compared with clinical diagnosis of genito-urinary tuberculosis in adult males. J Urol 61:1078–1088

    PubMed  CAS  Google Scholar 

  21. Migliori GB, Loddenkemper R, Blasi F, Raviglione MC (2007) 125 years after Robert Koch’s discovery of the tubercle bacillus: the new XDR-TB threat. Is „science“ enough to tackle the endemic? Eur Respir J 29:423–427

    Article  PubMed  CAS  Google Scholar 

  22. Moussa OM, Eraky I, El Far MA et al (2000) Rapid diagnosis of genitourinary tuberculosis by PCR and non-radioactive DNA hybridization. J Urol 164:584–588

    Article  PubMed  CAS  Google Scholar 

  23. Robert Koch-Institut (2011) Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2009.

  24. Shin KY, Park HJ, Lee JJ et al (2002) Role auf early endourologic management of tuberculous ureteral strictures. J Endourol 16:755–758

    Article  PubMed  Google Scholar 

  25. Skutil V, Varsa J, Obsitnik J (1985) Six-month chemotherapy for urogenital tuberculosis. Eur Urol 11:170–176

    PubMed  CAS  Google Scholar 

  26. Stepanshina VN, Panfertsev EA, Korobora OV et al (1999) Drug-resistant strains of Mycobacterium tuberculosis isolated in Russia. Int J Tuberc Lung Dis 3:149–152

    PubMed  CAS  Google Scholar 

  27. Watterson SA, Drobniewski FA (2000) Modern laboractory diagnosis of mycobacterial infections. J Clin Pathol 53:727–732

    Article  PubMed  CAS  Google Scholar 

  28. World Health Organization (WHO) (2003) Treatment of Tuberculosis: Guidelines for National Programs, 3. Aufl. Genf

  29. World Health Organization (WHO) Anti-tuberculosis drug resistance in the world. Report No. 4. WHO/HTM/TB/2008.394

  30. World Health Organization (WHO) (2010) Global Tuberculosis Control 2010: Epidemiology, Strategy, Financing. WHO/HTM/TB 2010.7. Genf

  31. Takahashi S, Hashimoto K, Miyamoto S et al (2005) Clinical relevance of nucleic acid amplification test for patients with urinary tuberculosis during antituberculosis treatment. J Infect Chemother 11:300–302

    Article  PubMed  CAS  Google Scholar 

  32. Le CV, Hoang NPC (2010) Genitourinary tuberculosis in a developing country (Vietnam): diagnosis and treatment. In: Naber KG, Schaeffer JA, Heyns CF et al (Eds) Urogenital Infections, European Association of Urology/International Consultation on Urologic Diseases, Edition 2010. S 892–902

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Privatpraxis für Urologie und Andrologie, Müggelwerderweg 31, 12589, Berlin, Deutschland

    S. Lenk

Authors
  1. S. Lenk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Lenk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lenk, S. Urogenitaltuberkulose in Deutschland. Urologe 50, 1619–1627 (2011). https://doi.org/10.1007/s00120-011-2700-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-011-2700-x

Schlüsselwörter

Keywords

Search

Navigation