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[Aspects of evolving urogenital tuberculosis. 60 cases]
A Mnif1, H Loussaief, L Ben Hassine
1Service d'Urologie, Hôpital Charles Nicolle, Tunis.
Insights
Urogenital tuberculosis is a serious condition, predominantly affecting males, often presenting with cystitis and back pain. Delayed diagnosis significantly impacts patient outcomes, highlighting the need for earlier detection and treatment.
Area of Science:
- Urology
- Infectious Diseases
- Public Health
Background:
- Urogenital tuberculosis (UTB) remains a significant health concern despite global control efforts.
- Delayed diagnosis is a primary driver of severe disease and poor outcomes in UTB.
Purpose of the Study:
- To review the clinical features, diagnostic findings, and treatment outcomes of urogenital tuberculosis.
- To emphasize the impact of delayed diagnosis on the severity and management of UTB.
Main Methods:
- Retrospective study of 60 patients treated between 1984 and 1994.
- Analysis of clinical presentation, diagnostic imaging (Intravenous Urography - IVU), urine cultures, treatment regimens, and surgical interventions.
Main Results:
- Male predominance (65%) with a mean age of 48 years.
- Common symptoms include cystitis and low back pain; IVU revealed pathology in 98.3% of cases.
- High rates of serious disease, including renal destruction (43 cases) and renal failure (4 cases); 91% clinical improvement post-surgery.
Conclusions:
- Urogenital tuberculosis presents with distinct clinical features and often severe pathology.
- Effective treatment involves multi-agent tuberculostatic therapy and often surgical intervention.
- Delayed diagnosis remains a critical challenge, underscoring the need for increased awareness and prompt diagnostic measures.
Abstract:
Based on the results of a retrospective study of 60 patients treated between January 1984 and December 1994, the authors review the current clinical features of urogenital tuberculosis. The sex-ratio shows a male predominance of 65%. The mean age is 48 years. Cystitis and low back pain are the main symptoms of the disease. IVU, performed in all patients, showed pathological images in 98.3% of cases. Urine culture was positive in 23 out of the 50 cases in which it was performed. Serious forms were relatively frequent, with bilateral lesions in 12 cases, associated with renal failure in 4 of them, or unilateral renal destruction in 43 cases. All patients were treated with triple- or quadruple-agent tuberculostatic therapy. 54 patients required one or several surgical procedures: 43 nephrectomies, 7 ureterovesical reimplantations, 11 augmentation enterocystoplasties, 1 Bricker ureteroileostomy, 3 ureterostomies, 1 ureteric resection and 4 epididymectomies. Two patients admitted in a context of deterioration of the general state died during the days following admission. 56 patients were reviewed with a minimum follow-up of 6 months. Two were cured by medical treatment alone. Among the 54 operated patients, clinical improvement was obtained in 43 patients (91%) and radiological improvement was obtained in 33 of the 36 cases in which IVU was performed (91%). In conclusion, despite the various anti-tuberculosis campaigns, urogenital tuberculosis remains a serious disease, essentially because of the delayed diagnosis.