Genitourinary Tuberculosis case presentation.ppt

Genitourinary tuberculosis (GUTB) usually involves the urinary tract or genital organs due to the hematogenous spread of chronic latent pulmonary tuberculosis. The diagnosis of GUTB is often delayed due to symptoms and signs often being masked by another disease, usually a urinary tract infection (UTI). Resistant or recurrent urinary tract infections should be tested for GUTB without delay. This activity outlines the evaluation and treatment of genitourinary tuberculosis and highlights the role of an inter-professional team to improve outcomes in patients affected by GUTB.

3. Presented by
Dr. Md. Saiful islam
MS(Urology) 3rd Part Student
Orange Unit, Dept. of Urology
National Institute of Kidney Diseases and Urology.

4. Dulal28yrsoldfarmerfromLaxmipur,was
admittedintoNIKDUon30.10.2018withcomplaints
of
Rightloinpainfor6monthsand
Lowgradefeveralongwithburningsensation
duringmaturationforsameduration.

5. Painwassuddeninonset,nonradiating,moderate
inseverity&dullachinginnature.Therewasno
aggravatingfactor.Painwasrelievedbytaking
analgesics.

6. Thepatientalsocomplainedoflowgradefeverfor
thesameduration.Feverwasintermittent,not
associatedwithchills&rigor,highestrecorded
tempwas102F&subsidedaftertaking
paracetamol.

7. Healsocomplainedofburningsensationwith
frequencyofmicturationinbothdayandnightwith
dysuria,notrespondingtotraditionalmedication.
Helostabout5kgsofweightinlast6months.

8. Hehadnohistoryofhaematuria,pyuria,calcuria,
jaundice,bonepain,coughoranyothersystemic
symptom.
Hehadhistoryoftreatmentcompletedpulmonary
tuberculosis2yrsback.
Heisnormotensive,nondiabetic&nonasthmatic.

9. Ongeneralexamination-paitentisanaemic&body
buildwasbelowavarage.Allthevitalparameters
werewithinnormalrange.
Ongenitourinarysystemexamination-deep
tendernesswaselicitedinrightloin.
Restofthegenitourinarysystem,abdomen&
othersystemicexaminationrevealsnothing
contributory.

11. 1.RightchronicPyeloneophritis
2.Genitourinarytuberculosis
3.Rightrenalstone

12. Investigations?

14. •CBC:Hb-10gm/dl,
•ESR-10in1sthr
•TC-11350/dl
•RBS-6.5mmol/L
•S.Creatinine-1mg/dl
•UrineR/M/E-Normal
•UrineforC/S:Nogrowth
•CXR:Calcifiedpulmonarylesion

19. Faintnephrogramnotedonrightside
WellexcretingLeftkidney

24. Urethrocystoscopy with right
RGP & proceed

26. Date:12/11/18
EUM,Urethra,Bladderneck,UB-Normal
Lturetericorifice-Normal
Rturetericorifice-Swollen,Inflamed,Elevated.
RGPshowed-narrowlongsegmentstricturein
lowerthirdofureter.Multiplesmallnarrowings
werenotedinrightproximalureterwithHDUN

27. Biopsy from right ureter and ureteric orifice taken
4 Fr DJ stent was placed in Rt ureter under C-arm
guidance successfully.

29. Chronicnonspecificureteritis&attempted
granulationformation.
Suggestiveoftuberculosis.

30. Urine for GeneXpert –Positive for MTB

31. Antituberculardrugsof6monthsregimen
Reviewafter2monthforchangingofDJ
stent