Urogenital tuberculosis is the term used to describe tuberculosis of the genitourinary system. It is neither a venereal disease nor a primary tuberculous disease. Rather, genitourinary tuberculosis is one of several possible secondary forms of tuberculosis.
What is genitourinary tuberculosis?
Genitourinary tuberculosis is a form of secondary tuberculosis in which the organs of the genitourinary system are affected. It usually develops as a result of primary tuberculosis infection of the lungs. Although urogenital tuberculosis is not a venereal disease, the disease is reportable by name. In the countries of Central Europe, urogenital tuberculosis is very rare. Most of the disease occurs in two age groups. These are, on the one hand, 25- to 40-year-old patients and, on the other hand, patients of advanced age, especially residents of old people’s homes. Relatively few cases of urogenital tuberculosis are also observed in Germany. For example, in 2006, 1,091 cases of tuberculosis were recorded nationwide in which organs outside the lungs were affected (extrapulmonary tuberculosis). However, tuberculosis of the genitourinary system accounted for only 27 cases, or 2.5 percent.
Causes
Tuberculosis disease initially manifests in a different location; often the so-called primary focus is in the lungs. As the disease progresses, however, the tuberculosis pathogens can also infect other organs, to which they usually reach via the bloodstream. Secondary or organ tuberculosis can then develop. If the kidneys, adrenal glands, urinary tract and urinary bladder or reproductive organs are affected by such a settlement of tuberculosis pathogens originating from the primary focus, urogenital tuberculosis develops.
Typical symptoms and signs
- Mostly symptom-free
- Pain and burning during urination
- Flank pain
- Blood in urine
- Constipation
- Flatulence
- Bleeding between periods or menstrual irregularities in women
Diagnosis and course
Approximately twenty percent of cases of genitourinary tuberculosis cause no symptoms to affected patients. If symptoms do occur, they tend to be uncharacteristic, such as discomfort during urination, flank and other pain, pyuria or blood in the urine, and flatulence and constipation. In women, bleeding disorders or absence of menstruation are also observed. If the male epididymis is affected, painful swelling and redness may develop. Various methods are used to diagnose genitourinary tuberculosis. The tuberculin test plays an important role, but is not conclusive and must therefore be combined with other diagnostic procedures. A chest x-ray is used to clarify whether the patient has primary pulmonary tuberculosis. Other diagnostic procedures include cultural detection of TB pathogens in urine, which takes about four weeks, polymerase chain reaction (PCR) for pathogen detection in urine, urography, laparoscopy, and pathogen detection in histological specimen by polymerase chain reaction (PCR). In female patients with suspected urogenital tuberculosis, there is also the possibility of pathogen detection in menstrual blood or a biopsy of the endometrium. At the beginning of urogenital tuberculosis, so-called minimal lesions initially develop in the tissue of the kidney or other urogenital organs. Subsequently, a caseating tuberculoma forms, which over time develops into a calcified district. The further course of the disease depends largely on the immune status of the affected patient. As urogenital tuberculosis progresses, central tissue destruction (necrosis) and calcification in the kidney increase. The close juxtaposition of necrotizing sections and the cavity system in the kidney favors the development of deformities. For example, caliceal caverns, renal calices, papillary necrosis, as well as caliceal neck stenosis or renal pelvic outlet stenosis may develop. The final stage of renal tuberculosis is the so-called putty kidney. In this stage, the organ consists almost entirely of caseating necrosis and has completely lost its function.If scarring forms in the ureters as a result of urogenital tuberculosis, this can lead to urinary retention and, in the worst case, to hydronephrosis, which can then also lead to loss of function of the affected kidney. In addition to the problems described in the area of the kidneys and urinary tract, urogenital tuberculosis can also manifest itself in the female or male genitals. In women, almost all cases result in bilateral infestation of the fallopian tube mucosa and spread of the infection to the uterus. When the infection reaches the uterine cavity, it often leads to infertility. In developing countries, such as Bangladesh and India, genitourinary tuberculosis is one of the most common causes of infertility in women, and in earlier years, tuberculosis of the female genitalia was often found as an incidental finding during infertility diagnosis. In men, tuberculosis pathogens can reach the epididymis via the bloodstream, and sometimes without kidney involvement. The pathogens can also spread to the testicles and the prostate via the seminal ducts. If tuberculosis affects the genital organs, the disease must be expected to lead to infertility in about nine out of ten cases.
Complications
Genitourinary tuberculosis does not necessarily cause symptoms or lead to complications in every case. In some cases, it can also run completely symptom-free, so that it is also diagnosed relatively late for this reason. In many patients, however, urogenital tuberculosis leads to very severe pain during urination. This pain is burning and has a very negative effect on the patient’s psychological state, so that depression or other psychological upsets can sometimes occur. Flank pain can also occur in this process and make the daily life of the affected person more difficult. The urine is bloody in urogenital tuberculosis, which can also lead to a panic attack. Furthermore, the disease also leads to flatulence or to constipation and reduces the patient’s quality of life enormously. In women, the disease can also cause heavy menstrual bleeding and pain in the process. In most cases, urogenital tuberculosis can be treated relatively easily with the help of medication. No particular complications are to be expected. However, those affected are dependent on taking the medication for a long time. With successful treatment, the patient’s life expectancy is not negatively reduced by the disease.
When should you see a doctor?
Since urogenital tuberculosis cannot be cured independently, the affected person should see a doctor at the first symptoms or signs of the disease. Only early diagnosis and treatment can prevent further complications or further worsening of symptoms. A doctor should be contacted if the patient suffers from pain during urination. There is usually a slight burning sensation or even itching. In many cases, urogenital tuberculosis is also noticeable by bloody urine. Some affected individuals also suffer from constipation or bloating, resulting in a significantly reduced quality of life. In women, urogenital tuberculosis can also lead to intermittent bleeding or a disturbed menstrual cycle. Here, too, a doctor should be contacted if the symptoms are permanent and do not disappear on their own. Usually, urogenital tuberculosis can be treated well by a urologist.
Treatment and therapy
Standard treatment for urogenital tuberculosis today is combination therapy. Isoniazid, rifampicin, and pyrazinamide are usually used. If necessary, these agents can also be combined with ethambutol. The therapy must be continued consistently over a longer period of time. Normally, six months should be assumed. If therapy is ineffective, surgical resection must usually be performed. This is especially true if urogenital tuberculosis has led to the development of a putty kidney or hydronephrosis.
Prevention
Because urogenital tuberculosis is a secondary disease, direct prevention is not possible. Therefore, the most effective prophylaxis is to avoid primary infection or to diagnose it as early as possible.This is because the earlier a primary tuberculosis infection, for example in the lungs, is detected and treated, the lower the risk of pathogen colonization and the development of organ tuberculoses such as urogenital tuberculosis.
Follow-up
Follow-up care after urogenital tuberculosis has been overcome depends on the therapy used. Because it is not a primary disease but a secondary disease, there is no risk of infection, which simplifies behavior during drug treatment, which can last up to 18 months. Normally, the disease is cured during long-term therapy. It is crucial that the patient strictly adheres to the instructions for taking the medication, even if this is associated with unpleasant side effects. Aftercare following successful medication is then mainly aimed at strengthening the body’s own immune system in order to avoid relapses as far as possible. Despite actual or apparent cure of urogenital tuberculosis, further follow-up treatment consists of self-monitoring. If symptoms appear that suggest a possible return of the disease, a wide variety of examination methods can provide clarity. It then becomes clear whether it is a false alarm or whether one of the organs in question is affected. In some cases, the findings may even be advanced. These indicate the need for immediate action. This may then consist not only of a renewed medication phase, but under certain circumstances surgical interventions may become necessary in order to eliminate stenoses or to interrupt and halt the progression of urogenital tuberculosis in certain organs. These serious cases also require parallel treatment with medications.
Here’s what you can do yourself
Genitourinary tuberculosis is treated with medication. The most important self-help measure is to follow the doctor’s instructions regarding the use of medications. Typically used preparations such as isoniazid or rifampicin often cause side effects such as gastrointestinal disturbances or allergies. If complaints of this kind are noticed, a visit to the doctor is recommended. After six months of combination therapy, the urogenital tuberculosis should have subsided. If the treatment does not work, a surgical attack is necessary. After surgery, the surgical wound must be carefully observed so that any inflammation or bleeding can be treated quickly. In the event of complications, rapid medical clarification is also required. Accompanying this, patients should cool the affected area well and care for it carefully. The doctor can prescribe suitable disinfectants that can be used to treat the wound optimally. If necessary, natural remedies from the field of homeopathy can also be used. This must first be discussed with the attending physician. Genitourinary tuberculosis can significantly limit well-being, which is why the focus after the disease is on regaining quality of life. Patients can now resume hobbies, lifestyle habits, and professional activities that were neglected during the several-month therapy phase.
