eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Tuberculosis of the Genitourinary System: Follow-up

Author: Mohamed S Soliman, MD, Consulting Staff, Integral Healthcare of Cheraw
Coauthor(s): Klaus-Dieter Lessnau, MD, FCCP, Clinical Assistant Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital; Aizid Hashmat, MD, Chairman, Department of Urology, Brooklyn Hospital Center
Contributor Information and Disclosures

Updated: Dec 27, 2007

Follow-up

Further Inpatient Care

  • Use surgical intervention as needed.
  • Treat comorbid conditions.

Further Outpatient Care

  • If the patient is not complying with therapy, use direct observation therapy 2-3 times a week.

Deterrence/Prevention

  • Maintain a high degree of clinical awareness for genitourinary tuberculosis (GUTB).
  • Screen emigrants from endemic areas. If an emigrant from a TB-endemic area has intermittent recurrent urinary tract infections after several courses of antibiotics, obtain a purified protein derivative (PPD) skin test and serial early-morning urine samples to test for acid-fast bacilli to evaluate for GUTB.
  • Screen sex partners and family members.
  • Before starting medications, investigate regional drug-resistance data.
  • Researchers now question the use of Bacille Calmette-Guérin (BCG) vaccine, even in developing countries, because TB is diagnosed in vaccinated persons. Additionally, the BCG vaccine is not cost-effective in developing countries.
  • The chemoprophylaxis protocol for unconfirmed clinical disease is INH for 6 months (9 mo in patients who are HIV positive), INH and rifampin for 3 months, or rifampin and pyrazinamide for 2 months.

Complications

  • Stricture
  • Obstruction
  • Superinfection
  • Abscess
  • Sinus formation
  • Renal hypertension
  • Scarring of renal parenchyma, loss of renal function, and, eventually, end-stage renal disease
  • Stricture and obstruction of ejaculatory duct or vas deferens may cause azoospermia and sterility. Similarly, involvement of fallopian tubes or endometrium may lead to infertility, which is common in developing countries.
  • Congenital TB: Culture-positive pulmonary TB in newborns and endometrial TB in mothers have been documented.

Prognosis

  • Good
    • Early detection of disease
    • Young age
    • Sensitivity to first-line medications
    • Absence of comorbid conditions
    • Compliance with medications and follow-up care
    • Good social support system
  • Poor
    • Late detection with complications
    • Low socioeconomic group
    • Old age
    • Other immunocompromising conditions

Patient Education

  • Crucial education issues include long-term compliance, preventive measures, and early detection in other persons.
  • GUTB can be sexually transmitted until treatment clears mycobacteria from semen, urine, or other genital secretions. Mycobacteria usually clear approximately 4 weeks after appropriate medications are started.
  • For excellent patient education resources, visit eMedicine's Men's Health Center, Women's Health Center and Bacterial and Viral Infections Center. Also, see eMedicine's patient education article Tuberculosis.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider renal tuberculosis (TB) in any nondiscrete renal calcification
  • Failure to offer HIV testing to all patients with TB
  • Failure to perform a full workup for malignancies if tubercles or ulcers are present away from ureteric orifices, if genital ulcers are present, or with suspicious renal lesions
  • Failure to recognize, prevent, and treat adverse medication effects
  • Failure to inform patients that genitourinary tuberculosis (GUTB) may cause sterility in females
  • Failure to consider genital TB in a male sex partner if the female has persistent, swollen, painful inguinal lymph nodes and no obvious source of infection

Special Concerns

  • In developed countries, the incidence of TB is decreasing at rate of 12%, which means the disease will take 30 more years to eradicate. No noticeable decrease is occurring in developing countries.
 


More on Tuberculosis of the Genitourinary System

Overview: Tuberculosis of the Genitourinary System
Differential Diagnoses & Workup: Tuberculosis of the Genitourinary System
Treatment & Medication: Tuberculosis of the Genitourinary System
Follow-up: Tuberculosis of the Genitourinary System
Multimedia: Tuberculosis of the Genitourinary System
References
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Further Reading

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Keywords

tuberculosis, genitourinary tuberculosis, urinogenital tuberculosis, urinogenital TB, TB, genitourinary TB, GUTB, renal tuberculosis, renal TB, urethral tuberculosis, urethral TB, bladder tuberculosis, bladder TB, thimble bladder, prostatic tuberculosis, prostatic TB, fallopian tuberculosis, penile tuberculosis, sterile pyuria, Mycobacterium tuberculosis, M tuberculosis, high-resolution transrectal ultrasonography, TRUS, sexually transmitted disease, STD, sexually transmitted infection, STI, ureteral tuberculosis, ureteral TB, epididymal TB, epididymal tuberculosis, tuberculous epididymoorchitis, tuberculous ulcer, endometrial TB, endometrial tuberculosis

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Contributor Information and Disclosures

Author

Mohamed S Soliman, MD, Consulting Staff, Integral Healthcare of Cheraw
Mohamed S Soliman, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP, Clinical Assistant Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Aizid Hashmat, MD, Chairman, Department of Urology, Brooklyn Hospital Center
Aizid Hashmat, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Allen Donald Seftel, MD, Department of Urology, Associate Professor, Case Western Reserve University
Allen Donald Seftel, MD is a member of the following medical societies: Ohio State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

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

 
 
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