Insights Into Urogenital Tuberculosis: Impact of Microbiological Diagnosis

Many varied presentations of genitourinary tuberculosis (GUTB) such as recurrent urinary tract infection, sterile pyuria (pus cells in urine despite a negative routine bacterial culture) with/without haematuria, irritating voiding symptoms, infertility, hydronephrosis and renal failure had been published in the literature. Tuberculous epididymo-orchitis (inflammation of the epididymis and testis) is an underreported and rare form of GUTB. Non-specific symptoms of epididymal tuberculosis (TB) are difficult to differentiate from cysts, tumours and other infections. Bilateral epididymal involvement with testicular lesion increases the suspicion of tubercular aetiology. Tuberculous epididymo-orchitis in late stages may present with non-functioning kidney and thimble bladder (a severely contracted, small-capacity bladder due to chronic inflammation) and infertility. Timely diagnosis and treatment will prevent late sequelae of the disease. Here, we present three cases of GUTB in young males: two cases of isolated tuberculous epididymo-orchitis (cases 1 and 3) and one case of complicated drug-resistant genitourinary tuberculosis (case 2). These rare cases were managed successfully with diagnostic and therapeutic challenges.