Primary genitourinary tuberculosis: rapid progression and tissue destruction during treatment

Area of Science:

• Urology
• Infectious Diseases
• Pathology

Background:

• Genitourinary tuberculosis (GUTB) is a significant global health concern, often presenting with subtle symptoms.
• Primary GUTB, without evident primary infection elsewhere, poses diagnostic challenges.

Observation:

• A case of primary genitourinary tuberculosis is presented, characterized by rapid, severe scarring and obstruction.
• The patient developed a contracted bladder with persistent vesicoureteral reflux and a bulbar urethral stricture.
• Tissue destruction progressed rapidly, commencing soon after the initiation of medical therapy.

Findings:

• The extensive scarring led to the necessity of a left nephrectomy.
• Surgical reconstruction included colocystoplasty, right ureteral reimplantation, and urethroplasty.
• The case highlights the potential for aggressive disease progression despite standard treatment.

Implications:

• Patients with genitourinary tuberculosis require vigilant monitoring from the commencement of drug therapy.
• Early recognition and management of complications are vital to prevent irreversible renal damage.
• Surgical intervention plays a critical role in reducing morbidity and conserving renal function in severe GUTB cases.