Skip to main content
SpringerLink
Log in

An update on lower urinary tract tuberculosis

  • Published:
Current Prostate Reports

Abstract

Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guérin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.

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

Similar content being viewed by others

References and Recommended Reading

  1. Centers for Disease Control and Prevention: Trends in tuberculosis: United States, 2005. MMWR Morb Mortal Wkly Rep 2006, 55:305–308.

    Google Scholar 

  2. Centers for Disease Control and Prevention: Reported tuberculosis in the United States, 2005. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at http://0-www.cdc.gov.mill1.sjlibrary.org/nchstp/tb/surv/surv2005. Accessed December 25, 2006.

    Google Scholar 

  3. Lanjewar DN, Ansari MA, Shetty CR, et al.: Renal lesions associated with AIDS: an autopsy study. Indian J Pathol Microbiol 1999, 42:63–68.

    PubMed  CAS  Google Scholar 

  4. Perez S, Andrade M, Bergel P, et al.: A simple algorithm for the diagnosis of AIDS-associated genitourinary tuberculosis. Clin Infect Dis 2006, 42:1807–1808.

    Article  PubMed  Google Scholar 

  5. Johnson C, Lowe FC, Johnson WD Jr: Genitourinary tuberculosis. AUA Update Ser 2003, 22:303–307.

    Google Scholar 

  6. Nzerue C, Drayton J, Oster R, Hewan-Lowe K: Genitourinary tuberculosis in patients with HIV infection: clinical features in an inner-city hospital population. Am J Med Sci 2000, 320:299–303.

    Article  PubMed  CAS  Google Scholar 

  7. Antoine D, Maguire H, Story A: Epidemiology and response to the growing problem of tuberculosis in London. Euro Surveill 2006, 11:11–14.

    Google Scholar 

  8. Lenk S, Schroeder J: Genitourinary tuberculosis. Curr Opin Urol 2001, 11:93–98.

    Article  PubMed  CAS  Google Scholar 

  9. Lado Lado FL, Tunez Bastida V, Golpe Gomez AL, et al.: Extrapulmonary tuberculosis in our area: forms of presentation [in Spanish]. An Med Interna 2000, 17:637–641.

    PubMed  CAS  Google Scholar 

  10. Kulchavenya E, Khomyakov V: Male genital tuberculosis in Siberians. World J Urol 2006, 24:74–78.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  12. Hsieh HC, Lu PL, Chen YH, et al.: Genitourinary tuberculosis in a medical center in southern Taiwan: an eleven-year experience. J Microbiol Immunol Infect 2006, 39:408–413.

    PubMed  CAS  Google Scholar 

  13. Cheng VC, Yam WC, Hung IF, et al.: Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol 2004, 57:281–285.

    Article  PubMed  CAS  Google Scholar 

  14. Wang LJ, Wong YC, Chen CJ, Lim KE: CT features of genitourinary tuberculosis. J Comput Assist Tomogr 1997, 21:254–258.

    Article  PubMed  CAS  Google Scholar 

  15. Pommerville PJ, Zakus P, van der Westhuizen N, Kibsey PC: Tuberculosis of the bladder without previous renal infection. Can J Urol 2006, 13:3044–3046.

    PubMed  Google Scholar 

  16. Rao A, Yvette K, Chacko N: Tuberculosis of urinary bladder presenting as pseudoureterocele. Indian J Med Sci 2005, 59:272–273.

    Article  PubMed  CAS  Google Scholar 

  17. Hemal AK, Aron M: Orthotopic neobladder in management of tubercular thimble bladders: initial experience and long-term results. Urology 1999, 53:298–301.

    Article  PubMed  CAS  Google Scholar 

  18. Mohan H, Bal A, Punia RP, Bawa AS: Granulomatous prostatitis: an infrequent diagnosis. Int J Urol 2005, 12:474–478.

    Article  PubMed  Google Scholar 

  19. Saw KC, Hartfall WG, Rowe RC: Tuberculous prostatitis: nodularity may simulate malignancy. Br J Urol 1993, 72:249.

    PubMed  CAS  Google Scholar 

  20. Oka N, Yamamoto Y, Kurokawa Y, et al.: A case of tuberculosis of the prostate presenting as endoscopically cavitary change [in Japanese]. Nippon Hinyokika Gakkai Zasshi 2001, 92:526–529.

    PubMed  CAS  Google Scholar 

  21. Fraietta R, Mori MM, De Oliveira JM, et al.: Tuberculosis of seminal vesicles as a cause of aspermia. J Urol 2003, 169:1472.

    Article  PubMed  Google Scholar 

  22. Birnbaum BA, Friedman JP, Lubat E, et al.: Extrarenal genitourinary tuberculosis: CT appearance of calcified pipe-stem ureter and seminal vesicle abscess. J Comput Assist Tomogr 1990, 14:653–655.

    Article  PubMed  CAS  Google Scholar 

  23. Reeve HR, Weinerth JL, Peterson LJ: Tuberculosis of epididymis and testicle presenting as hydrocele. Urology 1974, 4:329–331.

    Article  PubMed  CAS  Google Scholar 

  24. Chung JJ, Kim MJ, Lee T, et al.: Sonographic findings in tuberculous epididymitis and epididymo-orchitis. J Clin Ultrasound 1997, 25:390–394.

    Article  PubMed  CAS  Google Scholar 

  25. Gorse GJ, Belshe RB: Male genital tuberculosis: a review of the literature with instructive case reports. Rev Infect Dis 1985, 7:511–524.

    Article  PubMed  CAS  Google Scholar 

  26. Wolf JS Jr, McAninch JW: Tuberculous epididymo-orchitis: diagnosis by fine needle aspiration. J Urol 1991, 145:836–838.

    PubMed  Google Scholar 

  27. Kumar R, Hemal AK: Bilateral epididymal masses with infertility. ANZ J Surg 2004, 74:391.

    Article  PubMed  Google Scholar 

  28. Desmond N, Lynch M, Murphy D, Mulcahy F: Tuberculous epididymitis: a case report in an HIV seropositive male. Int J STD AIDS 1993, 4:178–179.

    PubMed  CAS  Google Scholar 

  29. Indudhara R, Vaidyanathan S, Radotra BD: Urethral tuberculosis. Urol Int 1992, 48:436–438.

    Article  PubMed  CAS  Google Scholar 

  30. Pal DK: Erectile failure and destruction of glans penis by tuberculosis. Trop Doct 1997, 27:178–179.

    PubMed  CAS  Google Scholar 

  31. Angus BJ, Yates M, Conlon C, Byren I: Cutaneous tuberculosis of the penis and sexual transmission of tuberculosis confirmed by molecular typing. Clin Infect Dis 2001, 33:E132–134.

    Article  PubMed  CAS  Google Scholar 

  32. Mahlberg FA, Rodermund OE, Muller RW: A case of circumcision tuberculosis [in German]. Hautarzt 1977, 28:424–425.

    PubMed  CAS  Google Scholar 

  33. Yachia D, Friedman M, Auslaender L: Tuberculous cold abscess of the corpus cavernosum: a case report. J Urol 1990, 144:351–352.

    PubMed  CAS  Google Scholar 

  34. Vijaikumar M, Thappa DM, Kaviarasan PK: Papulonecrotic tuberculide of the glans penis. Sex Transm Infect 2001, 77:147.

    Article  PubMed  CAS  Google Scholar 

  35. Yonemura S, Fujikawa S, Su JS, et al.: Tuberculid of the penis with a scab on the nodule. Int J Urol 2004, 11:931–933.

    Article  PubMed  Google Scholar 

  36. Klein TA, Richmond JA, Mishell DR Jr: Pelvic tuberculosis. Obstet Gynecol 1976, 48:99–104.

    PubMed  CAS  Google Scholar 

  37. Kumakech W, Zamblera D, Jolaoso A: The multifaceted presentation of tuberculosis in gynaecology: a masquerader as cervical cancer as well as a cause of primary infertility in the same patient. J Obstet Gynaecol 2006, 26:178–179.

    Article  PubMed  CAS  Google Scholar 

  38. Rakoto-Ratsimba HN, Samison LH, Razafimahandry HJ, et al.: Bartholin gland tuberculosis: a case report in Madagascar [in French]. Med Trop (Mars) 2003, 63:608–610.

    CAS  Google Scholar 

  39. Tripathy SN: Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynaecol Obstet 2002, 76:159–163.

    Article  PubMed  Google Scholar 

  40. Chavhan GB, Hira P, Rathod K, et al.: Female genital tuberculosis: hysterosalpingographic appearances. Br J Radiol 2004, 77:164–169.

    Article  PubMed  CAS  Google Scholar 

  41. Kumar S, Kekre NS, Gopalakrishnan G: Diagnosis and conservative treatment of tubercular rectoprostatic fistula. Ann R Coll Surg Engl 2006, 88:26.

    Article  PubMed  Google Scholar 

  42. Ansari MS, Singh I, Dogra PN: Spontaneous nephrocutaneous fistula: 2 unusual case reports with review of literature. Int Urol Nephrol 2004, 36:239–243.

    Article  PubMed  CAS  Google Scholar 

  43. Lamm DL: Efficacy and safety of bacille Calmette-Guerin immunotherapy in superficial bladder cancer. Clin Infect Dis 2000, 31(Suppl 3):S86–90.

    Article  PubMed  Google Scholar 

  44. LaFontaine PD, Middleman BR, Graham SD Jr, Sanders WH: Incidence of granulomatous prostatitis and acid-fast bacilli after intravesical BCG therapy. Urology 1997, 49:363–366.

    Article  PubMed  CAS  Google Scholar 

  45. Latini JM, Wang DS, Forgacs P, Bihrle W 3rd: Tuberculosis of the penis after intravesical bacillus Calmette-Guerin treatment. J Urol 2000, 163:1870.

    Article  PubMed  CAS  Google Scholar 

  46. Harada H, Seki M, Shinojima H, et al.: Epididymo-orchitis caused by intravesically instillated bacillus Calmette-Guerin: genetically proven using a multiplex polymerase chain reaction method. Int J Urol 2006, 13:183–185.

    Article  PubMed  Google Scholar 

  47. Aust TR, Massey JA: Tubercular prostatic abscess as a complication of intravesical bacillus Calmette-Guerin immunotherapy. Int J Urol 2005, 12:920–921.

    Article  PubMed  Google Scholar 

  48. Blumberg HM, Burman WJ, Chaisson RE, et al., American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of tuberculosis. Am J Respir Crit Care Med 2003, 167:603–662.

    Article  PubMed  Google Scholar 

  49. Gupta NP, Kumar R, Mundada OP, et al.: Reconstructive surgery for the management of genitourinary tuberculosis: a single center experience. J Urol 2006, 175:2150–2154; discussion 2154.

    Article  PubMed  CAS  Google Scholar 

  50. Hammer SM, Saag MS, Schechter M, et al.: Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society—USA panel. Top HIV Med 2006, 14:827–843.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, Maimonides Medical Center, 48-02 Tenth Avenue, Brooklyn, NY, 11219, USA

    Gilbert J. Wise MD

Authors
  1. Gilbert J. Wise MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex Shteynshlyuger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gilbert J. Wise MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wise, G.J., Shteynshlyuger, A. An update on lower urinary tract tuberculosis. Current prostate reports 5, 87–95 (2007). https://doi.org/10.1007/s11918-007-0012-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11918-007-0012-9

Keywords

Search

Navigation