Destructive forms of renal tuberculosis.

The incidence of renal tuberculosis has declined slowly in recent years, but its development has also changed. There are silent forms with few symptoms of spread and without very great bladder pain; nevertheless these forms can be very destructive, and even on first presentation may show a destroyed kidney. Our Urological Clinic in Belgrade treated 1,890 patients during a period of 23 years. We cannot incriminate streptomycin or PAS as the only causes of a tendency to fibrosis or for the silent forms of ureteric stenosis. Yet it seems certain that the pathogenesis of the tubercle bacillus changed in different persons under treatment with streptomycin and other antibiotics. The following represents the renal tuberculosis cases we have seen in the Urological Clinic in Belgrade during 1950--1972.     

Urological tuberculosis mimicking bladder tumour

A total of 8 patients have been treated in the recent 10 years in whom urogenital tuberculosis simulated the picture of bladder tumour. This occurred in 3% of overall patients with urogenital tuberculosis, i.e. primary diagnosis proved to be erroneous in such percentage of them. The course of the disease of 2 patients is reviewed in detail. In order to establish the differential diagnosis between the two diseases, the importance of bladder biopsy following polycystography is pointed out.     

The changed clinical picture of urogenital tuberculosis

Of the 4500 urological patients treated in Weil Emil Hospital in Budapest, in 5 years 140 (3.1%) cases of urogenital tuberculosis were detected. In these cases earlier examinations failed to reveal the process which manifested itself one to six months. The number of those needing surgical intervention decreased considerably, 34 (24.2%) of the patients were operated. The clinical pattern has changed in our days and the possibility of an urogenital tuberculosis must be considered whenever no explanation can be found for the complaints and when even a single one of the characteristic symptoms of urogenital tuberculosis is observed.     

Renal tuberculosis in the antibiotic era

At the Department of Urology in Belgrade 1424 patients were treated for renal tuberculosis in the period 1950 to 1967 (18 years). The number of patients affected with renal tuberculosis has been declining in the last years although, in relation to the incidence of other diseases, it should have been increased. This can be attributed to correct treatment of pulmonary tuberculosis in the course of which there are undoubtedly some healed cases with initial renal tuberculosis. Besides, the clinical and anatomical character of renal tuberculosis has also changed in recent years. Quiet forms without turbulent symptomatology are predominating. Anatomically medium forms are less frequent, as if a polarization had occurred toward light and very serious (destructive) forms. Conspicuous is the increase in the incidence of destructive forms and exclusion of the kidney, and particularly exclusion (on urography) with obliteration of the ureter. This can be attributed to the influence of the antibiotics, and perhaps also to a change of the pathogenic character of the mycobacterium itself (tendency toward fibrous forms). An outline is given of the observation of the 1424 patients with renal tuberculosis, of whom 405 patients showed exclusive forms.     

Recent changes in the assessment of urogenital tuberculosis

The urogenital tuberculosis has undergone a change in form and clinical assessment. The absolute proportion of urogenital tuberculosis cases has fallen off sharply since 1967. The number of surgical interventions is also remarkably reduced. The cases exhibiting a milder stage have significantly increased, while the severe cases have decreased. This change of tuberculosis has made a conservative therapy favorable; therefore the current operative indication is somewhat different than 15 years ago. The time of release from the stationary treatment depends first on the animal experiment and bacterial findings; furthermore, tests are necessary to determine the status of immunity. It was revealed with urogenital tuberculosis, through regular examination of the menstrual blood of women, that the number of positive cases among women was considerably higher, than among men. In contracted bladder a surgical intervention is often necessary due to intense pain and incontinence. We prefer the rectal bladder with sigmoid pull-through inside the sphincter ani, whereby excellent success can be achieved. The study shows that the clinical assessment of tuberculosis is somewhat different today than is was earlier. Tuberculosis underwent a change in form that must be taken into consideration with respect to operative indication.     

A rare cause of urinary obstruction: urogenital tuberculosis

The authors reported a rare cause of urogenital tuberculosis complicated by an obstructive acute renal failure in 44 years old man with solitary anatomic kidney. The authors insisted of using the upper urinary tract opacification by percutaneous nephrostomy for diagnosis, the urogenital tuberculosis with this exploration, we can suspected the tuberculosis by abnormalities of the radiologic imagine, and confirmed the koch bacilli urinary into urinary tract. The upper chance of positives of finding koch bacilli in higher than urinary bladder.     

Epidemiology of urogenital tuberculosis worldwide

Objectives: To characterize the epidemiology of urogenital tuberculosis worldwide and to compare the features of patients from developing countries to those from developed countries. Methods: A comprehensive search of articles published up to April 2008 using a combination of the terms ‘tuberculosis’, ‘genitourinary’, ‘renal’ and ‘urogenital’ was performed. Results: Urogenital tuberculosis affects more men than women (2:1), with a mean age of 40.7 years (range 5–90). In 26.9% of cases there is a non‐functioning unilateral kidney and in 7.4%, renal failure. Patients from developing countries are more likely to have a delayed diagnosis with a higher frequency of renal failure, unilateral non‐functioning kidney, ablative surgery and contracted bladder. Conclusions: Urogenital tuberculosis is a worldwide disease with more destructive behavior in developing countries where urgent strategies for early detection are particularly warranted.     

A new case of pseudotumoral renal tuberculosis

The incidence of urogenital tuberculosis is still frequent and constitutes a current public health problem in Morocco, a country in which tuberculosis is endemic. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon, and in this study this disease has been described in a young patient. The radiological findings suggested the possibility of this lesion being renal cancer. The preliminary diagnosis was corrected and a definitive diagnosis of pseudotumor was made following pathological examination of the surgically-removed kidney.     

Urogenital tuberculosis in children

The clinical and radiological features of 16 children with urogenital tuberculosis are reviewed. The possibility of urinary tract involvement should be considered in all children with evidence of past or active pulmonary tuberculosis, or who are primary contacts.     

Urogenital tuberculosis in 1974]

Urogenital tuberculosis, although often forgotten, remains a common and serious disease. Over a period of 10 years (1963 to 1973) 52 patients were seen and treated on our unit. There were 4 deaths all due to intercurrent disease, and 24 patients, i.e. half the survivors list one kidney owing to the tuberculosis. These crude figures, when one considers that they were mostly middle-aged adults, give an idea of the serious nature of urogenital tuberculosis in 1974.     

Renal tuberculosis: a case report

Tuberculosis or TB (tubercle bacillus) remains a major public health problem in developing countries. Over the last decades extra-pulmonary locations of the disease have become more frequent due to the increased prevalence of acquired immune deficiency syndrome and the increase number of organ transplants. The urogenital localization represents about 27% of all extra-pulmonary localizations of TB and may be due either to a disseminated infection or to a primitive genitourinary localization. The majority of patients, has pyuria, sometimes with hematuria. The diagnosis of urinary tuberculosis is based on the finding of pyuria in the absence of infection by common bacteria. The initial medical treatment includes isoniazide, rifampicin, pyrazinami-de, ethambutol and streptomycin. This disease should be suspected in patients with unexplained urinary tract infections, especially if immunocompromised and/or coming from endemic areas.     

Unilateral testicular tuberculosis: case report

Genitourinary tuberculosis (GT) includes 8-15% of extrapulmonary tuberculosis (TB), which is more frequent in men. Epididymides, seminal vesicles, prostate and testis are the most common sites of GT. Although testicular TB is uncommon, we report 2 patients with unilateral testicular TB. The main treatment of urogenital tuberculosis is anti-tuberculosis pharmacotherapy, sometimes combined with surgery.     

Urogenital tuberculosis in Israel

Forty-four patients were treated for urogenital tuberculosis in our ward from 1956 to 1975. Four patients were Israeli born and all the others were immigrants, mostly from Eastern Europe. Immigration greatly influences local morbidity, and tuberculosis is no exception. The highly developed preventive and social medicine of Israel has excellent results, and prognosis is more than favorable. Only one death was registered in our material, and this was due to renal failure of long duration.     

The diagnostic value of isotope renography in ranal tuberculosis

Experiences of 39 radioisotope, renographic measurements are described concerning 31 patients suffering from renal tuberculosis of different stages. For no group of diseases including tuberculosis did renography prove to be pathognostic. The method is suitable only for semiquantitative measurement of certain functions of kidneys and the upper urinary tract, resp., but inadequate for qualitative diagnosis. The diagnosis of urogenital tuberculosis should be based, therefore, on bacteriological and radiological examinations. The isotope renography is nevertheless a useful supplementary method to estimate the degree of parenchymal destruction, and the draining activity of the upper urinary tract. The method is free from risk and rather, sensitive, giving a good control tool to follow up the effectiveness of the bacteriostatic treatment. The occurrence of false negative results is claimed in case of small ulcerative processes. Observing false positivity the patient should be further examined by other methods, owing to the possibility of a subclinical tuberculous process. The renograms of 7 patients are presented in detail.     

Tuberculosis of the urogenital tract--guidelines for evaluation within the social compensation law and laws for the disabled

For the urologist who works as a consultant in the German "Social Compensation Law" tuberculosis of the urogenital tract is of current interest. The assessment of a causal connection represents no difficulty, when the existence of a pleuritis exsudativa is proven or when tuberculosis is accepted as being military service connected. For the assumption of a causal connection in the so called compensation law the probability is sufficient and it should be considered, that long term latencies are typical. The consultant must realize that today tuberculosis is a curable infection because of the effective chemotherapy. One must be aware of this by the determination of the MdE. In the future a term of recovery will not be justified as a whole. The final decision will be made only according to the extent of the remaining functional disturbances. On the basis of 358 examinations of the Compensation board in Giessen an outline of present evaluation of tuberculosis of the urogenital tract is presented.     

New features in the pathogenesis of renal tuberculosis and their significance for its detection.

The study of 1,464 cases of renal tuberculosis in 1946-1971 shows that the incidence of this illness has not diminished. The percentage of aged patients and of women has increased. The frequency of previous tuberculosis has decreased and the interval between tuberculosis and renal tuberculosis has increased. These new features show that the role of general pathogenic factors regresses whereas that of local factors progresses. Among the latter, the main factor is a disturbance of the urine outflow from the kidneys. This factor is of particular importance in women who had pathologic pregnancies and deliveries, gynecological diseases and surgery. While the connection of renal tuberculosis with tuberculous diseases diminishes its connection with urogenital conditions is rising. Accordingly, it is necessary to suspect and search for renal tuberculosis in new groups of persons: in older persons, in patients without a history of previous tuberculosis, in patients cured from tuberculosis, in women after obstetrical and gynecological complications, in patients with renal diseases, malformations, etc. Our preventive examinations indicated that nephrotuberculosis can be actively and earlier detected not only in patients with extrarenal tuberculosis but in persons cured from it, and in patients with local urogenital lesions.     

Renal tuberculosis of the aged

Problems in connection with renal tuberculosis developed by individuals over 50 years of age are discussed. Occurrence, frequency and pathology of old-age renal tuberculosis have been studied on the evidence of 180 autopsies and of 95 kidneys surgically removed and sent in by the Dept of Urology. The disease appears in aged individuals usually in the form of ulcerocavernous renal tuberculosis and only rarely in the nodular or indurative forms which point to increased immunologic resistance of the organism. Miliary tuberculosis does not invariably involve the kidneys. Non-specific pyelonephritis and arteriosclerosis, often present in old people, promote the development of renal tuberculosis. Antituberculous treatment facilitates the development of vascular lesions.     

Bone and joint tuberculosis in Denmark

Epidemiologic data on 100 patients with bone and joint tuberculosis reported in Denmark from 1980 to 1984 are presented. The annual incidence of skeletal tuberculosis remained unchanged during the period, although most other forms of tuberculosis showed a decreasing trend. Eighteen per cent of all the cases of bone and joint tuberculosis were found among young first generation immigrants, notably from Asia. In the native Danish population, bone and joint tuberculosis was almost exclusively found among the elderly. The lesions were most common in the spine and hip. Thirty per cent of the patients had a previous history of pulmonary tuberculosis.     

Bone and joint tuberculosis in Denmark

Epidemiologic data on 100 patients with bone and joint tuberculosis reported in Denmark from 1980 to 1984 are presented. The annual incidence of skeletal tuberculosis remained unchanged during the period, although most other forms of tuberculosis showed a decreasing trend. Eighteen per cent of all the cases of bone and joint tuberculosis were found among young first generation immigrants, notably from Asia. In the native Danish population, bone and joint tuberculosis was almost exclusively found among the elderly. The lesions were most common in the spine and hip. Thirty per cent of the patients had a previous history of pulmonary tuberculosis.     

Six-month chemotherapy for urogenital tuberculosis

Rifampicin (RMP, 600 mg), isoniazid (INH, 300 mg) and pyrazinamide (PZA, 1,000 mg) administered daily in the hospital for a duration of 2 months was followed at home by daily administration of 600 mg RMP and 300 mg INH for a duration of 4 months. 113 patients with previously untreated and bacteriologically proven urogenital tuberculosis were admitted to the study. Therapy was completed and evaluated in 106 (94%) patients. No failure of chemotherapy was observed during the treatment; one bacteriologically proven relapse occurred after completion of treatment within the 45- to 63-month follow-up. This 6-month chemotherapy seems as efficient as the standard treatment which lasted for 18-24 months.