Beyond UTI: Chronic Lower Urinary Tract Symptoms as a Manifestation of Genitourinary Tuberculosis: Case Series with...

Genitourinary tuberculosis (GUTB) is a significant cause of chronic lower urinary tract symptoms (LUTS) in endemic regions, yet it remains underdiagnosed owing to its nonspecific presentation and the frequent absence of bacteriuria. This case series highlights the clinical profile and diagnostic challenges of bladder tuberculosis (TB) in women presenting with chronic LUTS.

A retrospective review of seven female patients diagnosed with GUTB based on urine acid-fast bacilli (AFB) positivity (6 out of 7) between Jan 2024 and Dec 2024 at a tertiary care urogynaecology centre in India. Demographic details, symptom duration, prior TB history, investigation findings, treatment, and follow-up were analysed.

All patients presented with LUTS, including dysuria, urgency, frequency, nocturia, and incomplete bladder evacuation, with a symptom duration ranging from 1 to 15 years. Urine cultures were sterile in all cases. Urine AFB was positive in six patients; one was diagnosed on clinical-radiological correlation. Imaging findings included cortical scarring, hydronephrosis, bladder wall thickening, and significant post-void residual urine. Two patients had a prior history of urethral dilatation or surgical interventions. All received anti-tubercular therapy (ATT) for 6 months. Five patients reported ≥ 80% symptomatic relief; two had persistent frequency and urgency due to established bladder dysfunction.

Bladder TB should be considered in women with chronic LUTS, especially in TB-endemic areas and in cases unresponsive to antibiotics with sterile urine cultures. Urine AFB testing and early imaging are essential for timely diagnosis. Prompt ATT initiation may reverse symptoms and reduce the need for invasive procedures.