Urogenital tuberculosis

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Urogenital tuberculosis (UGTB) is a form of tuberculosis that affects the urinary system and the genital organs. It is caused by the bacterium Mycobacterium tuberculosis, which is known for affecting the lungs in the most common form of tuberculosis. However, it can also spread to other parts of the body, including the kidneys, ureters, bladder, and genital organs, leading to urogenital tuberculosis. UGTB is considered a form of extrapulmonary tuberculosis, which refers to tuberculosis infections outside of the lungs.

Epidemiology

Urogenital tuberculosis is the second most common form of extrapulmonary tuberculosis, following lymph node tuberculosis. It is more prevalent in countries with high rates of tuberculosis and in populations with compromised immune systems, such as individuals with HIV/AIDS. The incidence of urogenital tuberculosis has also been influenced by the global HIV pandemic, which has increased the susceptibility of individuals to tuberculosis infections.

Pathophysiology

The Mycobacterium tuberculosis bacterium usually reaches the urogenital tract through the bloodstream from a primary site of infection, often the lungs. The kidneys are typically the first organs affected in the urogenital system, which can then spread to the ureters and bladder. In males, the infection can spread to the epididymis and prostate, and in females, it can affect the fallopian tubes and endometrium. The progression of the disease can lead to significant damage to these organs, causing various complications.

Clinical Features

Symptoms of urogenital tuberculosis can vary widely and may include hematuria (blood in the urine), dysuria (painful urination), frequent urination, and flank pain. In advanced cases, it can lead to infertility, pelvic inflammatory disease in women, and epididymitis in men. Due to its nonspecific symptoms, UGTB is often misdiagnosed or diagnosed late.

Diagnosis

Diagnosis of urogenital tuberculosis involves a combination of medical history, physical examination, and various diagnostic tests. These tests may include urine cultures for Mycobacterium tuberculosis, imaging studies such as ultrasound, CT scans, and MRIs of the urogenital tract, and sometimes biopsy of the affected tissue. The Interferon Gamma Release Assays (IGRAs) and the tuberculin skin test (TST) can also be used to support the diagnosis.

Treatment

The treatment of urogenital tuberculosis follows the principles of treating pulmonary tuberculosis and involves a long course of multiple antituberculosis drugs. The most common regimen includes isoniazid, rifampicin, pyrazinamide, and ethambutol for the initial two months, followed by isoniazid and rifampicin for an additional four to six months. Surgical intervention may be necessary in cases where there is significant organ damage or obstruction.

Prevention

Prevention of urogenital tuberculosis involves controlling the spread of tuberculosis in general. This includes prompt diagnosis and treatment of active tuberculosis cases, vaccination with the BCG vaccine where it is recommended, and screening and treatment of latent tuberculosis infections, especially in high-risk populations.

Prognosis

With timely and appropriate treatment, the prognosis for individuals with urogenital tuberculosis is generally good. However, if left untreated, the disease can lead to severe complications, including irreversible damage to the urinary and genital organs.

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