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Abstract：
BACKGROUND: Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka.
METHODS: Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96).
RESULTS: There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease.
CONCLUSIONS: The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.
METHODS: Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96).
RESULTS: There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease.
CONCLUSIONS: The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.
摘要：
背景：尽管泌尿生殖系统结核病（GUTB）在大多数国家是肺外结核病的第二常见来源，斯里兰卡报告的GUTB比率仍然很低。迄今为止，尚未研究和记录斯里兰卡GUTB的特征。我们的目的是研究临床和影像学特征，斯里兰卡GUTB的治疗方式和结果。
方法：分析了由两个机构的一位泌尿外科医生连续21年治疗的患者的数据。包括所有微生物和/或组织病理学诊断为GUTB的患者。中位随访时间为24个月（范围：6-96）。
结果：82例患者，45例（54.9%）为男性。中位年龄为51岁（范围：26-75岁）。大多数患者（39%，n=32）在出现时有模糊的非特异性症状。常见的具体症状是血尿（15.8%，n=13）和阴囊表现（15.8%，n=13)。在70例患者中进行了Mantoux测试，在62例（88.5％）中>10mm。69例患者可获得红细胞沉降率，54例（78.3％）患者的红细胞沉降率>30mm。胸部X线和X线肾输尿管膀胱（KUB）异常分别为9例（11％）和6例（7.3％）。72例患者进行了CT尿路造影，57例（79％）患者发现异常。42例患者接受了膀胱镜检查，其中73.8％（n=31）有异常发现。43例（52.4％）的微生物学诊断是可行的，其余均经组织病理学诊断。最常见的器官是肾脏(64.6%，n=53),输尿管（51.2%，n=42),膀胱（43.9%，n=36)和睾丸/附睾(15.8%，n=13)。一名患者患有前列腺结核。然而，所有人都主要用抗结核药物治疗，50（61%）需要辅助治疗干预。大多数干预措施是重建手术（n=20，24.4％），其次是切除手术（n=19，23.2％）和引流程序（n=11，13.4％）。7例患者出现了抗结核药物的严重不良反应。五名患者出现顶针膀胱，并伴有残疾储存症状。八名患者在诊断时肾功能紊乱，三名患者出现肾功能进行性恶化，两名患者死于终末期肾病。
结论：抗酸杆菌的尿液组合，Mantoux测试,CT-尿路造影,在资源贫乏的环境中,膀胱镜检查和组织病理学是诊断GUTB的必要条件.大多数输尿管狭窄，无功能的肾脏和附睾肿块需要手术治疗。长期随访对于检测肾功能的进行性恶化至关重要。
方法：分析了由两个机构的一位泌尿外科医生连续21年治疗的患者的数据。包括所有微生物和/或组织病理学诊断为GUTB的患者。中位随访时间为24个月（范围：6-96）。
结果：82例患者，45例（54.9%）为男性。中位年龄为51岁（范围：26-75岁）。大多数患者（39%，n=32）在出现时有模糊的非特异性症状。常见的具体症状是血尿（15.8%，n=13）和阴囊表现（15.8%，n=13)。在70例患者中进行了Mantoux测试，在62例（88.5％）中>10mm。69例患者可获得红细胞沉降率，54例（78.3％）患者的红细胞沉降率>30mm。胸部X线和X线肾输尿管膀胱（KUB）异常分别为9例（11％）和6例（7.3％）。72例患者进行了CT尿路造影，57例（79％）患者发现异常。42例患者接受了膀胱镜检查，其中73.8％（n=31）有异常发现。43例（52.4％）的微生物学诊断是可行的，其余均经组织病理学诊断。最常见的器官是肾脏(64.6%，n=53),输尿管（51.2%，n=42),膀胱（43.9%，n=36)和睾丸/附睾(15.8%，n=13)。一名患者患有前列腺结核。然而，所有人都主要用抗结核药物治疗，50（61%）需要辅助治疗干预。大多数干预措施是重建手术（n=20，24.4％），其次是切除手术（n=19，23.2％）和引流程序（n=11，13.4％）。7例患者出现了抗结核药物的严重不良反应。五名患者出现顶针膀胱，并伴有残疾储存症状。八名患者在诊断时肾功能紊乱，三名患者出现肾功能进行性恶化，两名患者死于终末期肾病。
结论：抗酸杆菌的尿液组合，Mantoux测试,CT-尿路造影,在资源贫乏的环境中,膀胱镜检查和组织病理学是诊断GUTB的必要条件.大多数输尿管狭窄，无功能的肾脏和附睾肿块需要手术治疗。长期随访对于检测肾功能的进行性恶化至关重要。
