eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Prostatitis, Tuberculous: Differential Diagnoses & Workup

Author: Vernon M Pais Jr, MD, Assistant Professor, Department of Surgery, Section of Urology, Dartmouth Medical School
Coauthor(s): Levi A Deters, MD, Staff Physician, Department of Urology, Dartmouth Hitchcock Medical Center; Jason R Bylund, MD, Resident, Division of Urology, University of Kentucky; Andrew A Wagner, MD, Staff Physician, Department of Surgery, Division of Urology, University of Massachusetts Medical Center
Contributor Information and Disclosures

Updated: Jun 26, 2009

Differential Diagnoses

Actinomycosis
Interstitial Cystitis
Acute Bacterial Prostatitis and Prostatic Abscess
Prostate Hyperplasia, Benign
Blastomycosis
Prostatitis, Bacterial
Candidiasis
Urethral Cancer
Chronic Bacterial Prostatitis
Urethral Strictures
Churg-Strauss Syndrome
Urethritis
Cryptococcosis
Urinary Tract Infection, Males
Eosinophilic Granuloma (Histiocytosis X)
Wegener Granulomatosis
Epididymitis
Infertility
Infertility, Male

Other Problems to Be Considered

Fungal infections of the genitourinary tract
Postsurgical granulomatous prostatitis
Post–bacille Calmette-Guérin granulomatous prostatitis

Workup

Laboratory Studies

  • Urinalysis: Findings that demonstrate microscopic hematuria, albuminuria, or sterile pyuria should raise suspicion for genitourinary tuberculosis (TB) but do not definitively establish the diagnosis.
  • Culture of the urine and semen with drug-sensitivity profiling
    • Acid-fast bacilli (AFB) staining of urine and semen: Standard microbiological identification of prostatic involvement of M tuberculosis relies on culture and AFB staining results of semen and 3 early-morning urine specimens. AFB staining, while rapid, has a reported sensitivity of only 52%.
    • Culture: Although it is the criterion standard for mycobacterial identification, culture may require 10 days to 8 weeks for results. Because of the emergence of drug-resistant strains, sensitivities of the mycobacteria should be determined.
  • Polymerase chain reaction (PCR): Genomic amplification of M tuberculosis –specific DNA allows rapid identification of TB. The reported sensitivity and specificity of PCR are 95.6% and 98.1%, respectively. Results can be available within 48 hours.
  • Semen analysis: Although it is not a required test, semen analysis may be useful in the evaluation of male infertility associated with prostatic TB. The reported semen analyses of 53 patients with genital TB revealed low volume in 89% of patients and azoospermia or oligospermia in 53% of patients. Significant leukocytospermia was identified in 77.6% of patients with prostatic TB.
  • Prostate-specific antigen (PSA): PSA levels are elevated in only one third of patients. In 18 patients from a contemporary series, the median PSA level was 2.7 ng/mL (range, 0.3-31 ng/mL).
  • Sputum testing: Patients with confirmed prostatic TB should also undergo sputum testing.

Imaging Studies

  • Transrectal ultrasonography (TRUS): In persons with a soft or fluctuant prostate in whom abscess is suspected, TRUS is particularly useful. TRUS allows demonstration and localization of the collection and can then guide transrectal aspiration and drainage of any fluid for culture and microscopic examination.
  • Intravenous urography (IVU): An IVU or a CT scan should be obtained to determine the presence of concurrent renal TB. Of patients with prostatic TB, 72% have pathologic evidence of renal TB during autopsy.
  • CT scanning/MRI
    • Although they are not first-line studies, descriptions of CT scan and MRI findings in TB prostatitis have been published.
    • On a contrast-enhanced CT scan, prostatic tuberculosis may appear as hypodense lesions within the prostate. Additionally, focal calcifications may be identified.
    • MRI may reveal low signal-intensity lesions suggestive of abscess. These studies may also be useful in delineating the extent of any renal disease.
  • Radiography: A chest radiograph should be obtained to document active or chronic pulmonary involvement.

Other Tests

  • Intradermal injection of tuberculin purified protein derivative (PPD): When prostatic involvement is suspected in patients without a previous diagnosis of TB, a PPD test is a standard means of documenting exposure. False-negative results are possible, particularly during the 4-6 weeks before hypersensitivity develops and in persons who are immunosuppressed owing to various sources.

Procedures

  • Cystourethrography has been used to confirm and delineate the extent of a vesicoperineal fistula associated with prostatic TB.
  • Transrectal ultrasound–guided needle biopsies have been used to obtain tissue for a definitive diagnosis of the disease, to monitor response to therapy, and to ensure eradication of the prostatic disease.

Histologic Findings

Upon microscopic examination of prostatic TB samples, characteristic granulomas composed of Langhans multinucleated giant cells and epithelioid cells are noted, usually in association with central regions of caseous necrosis. Note that similar histologic changes can be seen in the prostates of patients treated with intravesical bacillus Calmette-Guérin for transitional cell carcinoma of the bladder.

More on Prostatitis, Tuberculous

Overview: Prostatitis, Tuberculous
Differential Diagnoses & Workup: Prostatitis, Tuberculous
Treatment & Medication: Prostatitis, Tuberculous
Follow-up: Prostatitis, Tuberculous
References
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Further Reading

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Keywords

tuberculous prostatitis, tuberculosis, TB, prostatic TB, prostatic tuberculosis, consumption, phthisis, Mycobacterium tuberculosis, M tuberculosis, prostatic urethral tuberculosis, prostatic urethral TB, prostatic parenchymal tuberculosis, prostatic parenchymal TB, tuberculous prostatic abscess, genitourinary tuberculosis, GU tuberculosis, genitourinary TB

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Contributor Information and Disclosures

Author

Vernon M Pais Jr, MD, Assistant Professor, Department of Surgery, Section of Urology, Dartmouth Medical School
Vernon M Pais Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, Endourological Society, Sigma Xi, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Levi A Deters, MD, Staff Physician, Department of Urology, Dartmouth Hitchcock Medical Center
Disclosure: Nothing to disclose.

Jason R Bylund, MD, Resident, Division of Urology, University of Kentucky
Disclosure: Nothing to disclose.

Andrew A Wagner, MD, Staff Physician, Department of Surgery, Division of Urology, University of Massachusetts Medical Center
Andrew A Wagner, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State College of Medicine
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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