An Evidence Atlas of Diagnostic Tests for Genitourinary Tuberculosis: A Laboratory-Centered Framework

Genitourinary tuberculosis (GUTB) remains difficult to diagnose because of nonspecific clinical manifestations, low bacterial burden, and variability in diagnostic performance across laboratory methods and specimen types. However, the current evidence landscape of laboratory diagnostic tests for GUTB remains fragmented.

A systematic literature review was conducted using PubMed, Embase, and Web of Science. Studies reporting laboratory diagnostic methods and diagnostic performance for GUTB were included. Core data regarding diagnostic methods, specimen types, diagnostic sensitivity, and turnaround time were extracted and integrated into an evidence atlas using evidence matrices, bubble plots, and Sankey diagrams.

A total of 21 studies were included in the evidence atlas. Urine-related specimens were reported in 19 of 21 studies (90.5%), while first-morning urine specimens were used in 9 studies (42.9%). Molecular diagnostic methods, particularly Xpert MTB/RIF, polymerase chain reaction/nucleic acid amplification tests (PCR/NAAT), and simultaneous amplification testing for tuberculosis (SAT-TB), represented the most frequently investigated diagnostic approaches in urine-based specimens. PCR/NAAT-based methods showed reported diagnostic sensitivity ranging from 42.9% to 94.3%, whereas Xpert MTB/RIF demonstrated reported sensitivity ranging from 39.0% to 89.0% across included studies. Evidence matrix and Sankey diagram analyses showed that urine and first-morning urine combined with molecular diagnostic methods represented the most evidence-rich diagnostic pathway in the current literature. In contrast, evidence related to special specimen types, histological examinations, and emerging molecular diagnostic technologies remained limited.

This evidence atlas provides a structured overview of the current evidence landscape of laboratory diagnostic tests for genitourinary tuberculosis. Urine-based specimens combined with molecular diagnostic methods currently represent the most extensively studied diagnostic pathway. Further studies involving special specimen types, emerging molecular diagnostic technologies, and high-risk populations are needed to strengthen the evidence base for laboratory diagnosis of genitourinary tuberculosis.