Genitourinary Presentation of Tuberculosis

Tuberculosis (TB) is less common in developed countries; however, the incidence of TB—especially resistant strains—is on the rise worldwide. Cases of TB manifesting as urologic complications are rare in the United States. Urologists should be aware of this potential manifestation, especially in patients who have recently immigrated to the United States or have traveled abroad for prolonged periods. Two cases are presented here to illustrate this entity.Key words: Tuberculosis, Genitourinary complications, Mycobacterium tuberculosisTuberculosis (TB) is a disease dating back to antiquity and has continued to thrive to the present time. Signs of TB have been found in Egyptian mummies dating back to 3000 to 2400 BCE,¹ and scholars have postulated that TB may have led to the deaths of Egyptian pharaoh Akhenaton (1353-1336 BCE) and his wife Nefertiti. TB, then known as “the consumption,” reached epidemic proportion in Europe in the 1700s, and was responsible for one in four deaths in England. The causative bacillus, Mycobacterium tuberculosis, and the mode of transmission were described by Robert Koch on March 24, 1882, which is now designated annually as World Tuberculosis Day.²In 2013, the World Health Organization estimated an annual rate of 9 million new TB cases, and it is second only to human immunodeficiency virus (HIV) and AIDS as a single infectious agent killer. TB is also a major cause of death in HIV-related mortalities. Globally, the incidence is declining, albeit slowly.³In the United States, the incidence of TB showed a resurgent increase, peaking in 1992 after decades of steady decline due to the emergence of HIV/AIDS; subsequently, the incidence of TB has continuously declined at the rate of 3% to 4% per year, with 9588 new cases reported in 2013. The majority of cases represent reactivation of latent TB acquired previously in foreign-born individuals, and reflects TB incidence in their countries of origin.⁴Extrapulmonary sites account for 10% of all TB cases; genitourinary TB accounts for 30% to 40% of all extrapulmonary cases, second to lymph nodal affection. Peak occurrence for urogenital TB is between the ages of 20 and 40 years, with a 2:1 ratio of men to women; it is more prevalent in developing countries.⁵Urogenital TB arises from hematogenous dissemination from the lungs; the kidney, epididymis, and prostate are the primary landing sites. The bacillus then gains access to other organs via direct or lymphatic means. Affected individuals are often free of any pulmonary symptoms or involvement.Signs and symptoms for urogenital TB are typically nonspecific and usually mimic a wide range of more commonly occurring urologic conditions. Lower urinary tract symptoms (LUTS), pyuria, hematuria, and pain are among the usual presenting symptoms; they are usually refractory to standard treatment regimens and are easily missed unless a high index of suspicion is exercised.