TB Prostate,Prostatitis,Prostate Abscess

Epidemiology prevalence,investigation and management of Ca prostate

1. Welcome!

2. TB of prostate & Prostatitis and prostate Abscess Dr V Vijayasarathy Department of General Surgery

3. What is the load in India? 10 million cases GUTB develops 2-20% of all pulmonary TB cases

4. Others In Developing countries 15-20% In the USA 3 cases /100000 In the UK in patients who had concurrent pul.TB 13.5% In an autopsy-based study in Germany 3.1%/ 5424

5. Epidemiology Primary tuberculosis of prostate is rare. GENITOURINARY TUBERCULOSIS 5-10% of Extra Pulmonary tuberculosis in developed countries  ​ 15-20 % in developing countries

6. Of all GUTB 6.6% is Prostate tuberculosis

7. Etiology Descending infection  Sporer et al -successive hematogenous seeding Predisposing –steroid use On immunosuppressant Rate in patients who  had BCG in Ca Bladder

8. PROSTATIC TB Hematogenous spread from primary focus Usually asymptomatic Voiding symptoms Dysuria Nocturia Pollakiuria due to prostatic enlargement Chronic pelvic pain Sexual  dysfunction

9. Clinical presentation Urethral discharge Painful sometimes blood stained ejaculation Ache in perinium Infertility Dysuria

10. DRE Enlarged prostate ,hard consistency ,nodular surface Some studies PSA 12ng/ml

11. INVESTIGATIONS CBC, USG X RAY OF CHEST URINE  PCR – SPECIFICITY  98.2%, SENSITIVITY 95.5% TRUS/CT/MRI PSA  NEEDLE BIOPSY SEROLOGY

12. Non -specific granulomatous infections 0.44% in routine prostatectomy 0.29%  in needle biopsy 0.77% in TURP AGE GROUP 18-86 MEAN AGE 62 YEARS

13. Causes of non specific granulomatous infection/prostatitis Treponema pallidum Viruses Fungi Intravesical BCG Due to the blockage of prostatic ducts and stasis of secretions

14. URINE/USG Urine culture sterile Heterogenous enlarged prostate, weight  65grams Post void Residual urine  150cc 

15. Pathophysiology Inhalation or Ingestion  Multiply in LUNG/GUT EVOKE A COMPLEX SERIES OF IMMUNE RESPONSE RESULTS IN COMPLETE ELIMINATION OF BACTERIA  OR FORMATION  OF PRIMARY GRANULOMA –GHON FOCUS SLOW REPLICATION RATE ,INTRACELLULAR  LOCATION OF THE BACILLI INSIDE THE MACROPHAGE LEADS TO A GAP FOLLOWING PRIMARY INFECTION FOR CLINICAL  GUTB TO DEVELOP

16. Nucleic acid amplification tests (NAATs) Results in 2-48 hours Classified by their mechanism Polymerase chain reaction PCR Ligase Chain reaction Variants of PCR- Xpert MTB/RIF assay simultaneously detects mycobacterium tuberculosis complex(MTBC) and resistance to RIFAMPICIN in less than 2 hours

17. Polymerase chain reaction  results in 6 hrs Highly sensitive more than 90% Specificity  of more than 95% When compared culture –sensitivity37% Bladder biopsy                                            47% Intravenous pyelography                        88% 

18. PCR tests in near equivalent quality Genus –specific 16S rRNA PCR test Species-Specific IS6110     PCR test Roche Ampicor MTB              PCR test Amplified M tuberculosis    DIRECT DETECTION TEST (AMDT)

19. Low numbers of mycobacteria  Detected with DNA probes provide species specification in a few hours Staining with Auramine or Rhodamine and examination via fluorescence microscopy Luciferase Bioluminescence is used in diagnosis of tuberculosis and AID in susceptibility testing

20. Radiography X Ray chest, 50% normal USG cystic or cavitary lesions KUB  CT  adjunct to IVU  CECT  MRI High Resolution TRUS

21. Urine studies Serial early –morning urine cultures (at least 3) for Acid fast bacilli. Still considered the criterion standard for  evidence of active tubercular disease .sensitivity  of 65% and specificity 100%. To be done immediately. L J medium results in 4 weeks BACTEC 360 MEDIUM IN 2-3 DAYS RADIOMETRIC 

22. PSA   Elevated in  third of the patients

23. Procedures FNA -Minimally invasive plays a prime role in the diagnosis of tubercular lesions in GUTB. AFB yield 60% To be avoided if neoplasm is suspected Histologic  findings in GUTB finding similar to TB elsewhere. Similar changes in TCC treated with BCG Trans rectal USG guided needle biopsy

24. Surgical ꝶ Trans urethral incision TURP Open perineal drainage

25. Normal

26. Needle biopsy

27. Prostatic TB Treatment Rifampicin 10mg/kg Isoniazid 5mg/kg Pyrazinamide 1gram Ethambutol 800mg First 2 months The first 2 drugs for 4 months

28. In MDR TB Fluroquinolone Bedaquiline Delamanid Aminoglycosides 18 to 24 months

29. Thank you!