URINARY TRACT TUBERCULOSIS

APPROACH AND EVALUATION

1. urinary tract tuberculosis

2. Urogenital tuberculosis (TB) is the third most common form of extrapulmonary TB (after lymph node involvement and tuberculous pleural effusion

3.   Urogenital TB occurs in 2 to 20 percent of individuals with pulmonary TB Up to 50 percent of patients have radiographic evidence of past infection and 10 percent may have active infection

4. Complications Hypertension ( Super-infection (12 to 50% AS axis mediated Nephrolithiasis (7 to 18%)

5. Complications

6. Symptoms and signs Classical TB symptoms like fever, weight loss, and night sweats are uncommon Symptoms are often non-specific, with >25% asymptomatic Abdominal (particularly back and flank) pain, LUTS, recurrent UTIs that are poorly antibiotic- responsive, macro- and microscopic hematuria, incontinence (bladder fibrosis), infertility in both sexes

7. Presumptive urinary TB A patient with lower urinary tract symptoms (frequency, urgency and nocturia) associated with dysuria and/or haematuria for at least 2 weeks, which has not responded to a 3–7 day course of antibiotics

8. Chest X-ray All patients presenting with symptoms consistent with TB, to look for evidence of previous or active pulmonary TB 30% may have an abnormal CXR

9. Urine microscopy and culture for non-mycobacterial organisms All patient to identify sterile pyuria which may suggest urinary tb To diagnose active ,superaded infection

10. Early morning urine sampling All patients Three to five early morning urine samples collected for staining and microscopy for AFBs and culture for Mtb Although sensitivity is low, culture remains the most reliable way to confirm urinary TB and allows drug susceptibility test

11. Ultrasound KUB All patients This scan may be normal in early disease Ultrasonography may reveal cystic or cavitary lesions, cortical scarring, hydronephrosis, and abscess in the kidneys

12. Intravenous urography Selected patients It has low sensitivity for early lesions Risks include contrast nephropathy and contrast reaction

13. IVU features

14. Contrast-enhanced CT urography Selected patients This test is more sensitive than IV urography Risks include contrast nephropathy and contrast reaction The relatively high dose of ionizing radiation involved, particularly for children and women of childbearing age It is contraindicated in pregnant women

15. MR urography without contrast Selected patients This test is also gives structural information and is sensitive for identifying and characterising TB lesions The advantage of not requiring intravenous contrast and not necessitating a dose of radiation Pregnant women, children and patients with pre- existing renal function may benefit

16. FNAC Urethro-cystoscopy with/without biopsy Biopsy

17. Treatment Aims of treatment are: To achieve TB cure To prevent the long term sequelae To restore normal anatomy

18. Drugs : 2RHZE/4RHE Duration : Six months

19. Longer courses of ATT Longer courses of ATT ranging from 9 months to 2 years are useful in patients Who do not tolerate Pyrazinamide

20. Patients With Chronic Kidney Disease

21. Treatment monitoring

22. . In cases of renal calcification , the patient should be evaluated yearly by three early morning samples of urine for culture of mycobacteria and by plain radiography of the abdomen for up to 10 years,

23. Referral Structural urinary tract complications Renal failure secondary to bilateral hydronephrosis

24. SURGERY NEPHRECTOMY PARTIAL NEPHRECTOMY NEPHROURETERECTOMY ABSCESS DRAINAGE

25. Nephrectomy Indications nonfunctioning kidney with or without calcification extensive disease involving the whole kidney, together with hypertension and UPJ obstruction coexisting renal carcinoma

26. Partial Nephrectomy Localized polar lesion containing calcification that has failed to respond after 6 weeks of intensive chemotherapy Area of calcification slowly increasing in size and may gradually destroy the whole kidney

27. caliectasis and multifocal strictures

28. putty kidney.”