Tuberculosis of the urogenital system is called urogenital tuberculosis. It is neither a sexually transmitted disease nor a primary tuberculous disease. Rather, urogenital tuberculosis is one of several possible secondary forms of tuberculosis.
What is urogenital tuberculosis?
Urogenital tuberculosis is a form of secondary tuberculosis affecting the organs of the urogenital system. It usually develops as a result of a primary tuberculosis infection of the lungs. For kanner syndrome explained, please visit psyknowhow.com.
Although urogenital tuberculosis is not a sexually transmitted disease, the disease is notifiable by name. In the countries of Central Europe, urogenital tuberculosis is observed only very rarely. Most of the diseases occur in two age groups. On the one hand, these are 25 to 40-year-old patients and, on the other hand, elderly patients, especially residents of old people’s homes.
In Germany, too, only relatively few cases of urogenital tuberculosis are observed. For example, in 2006, 1,091 cases of tuberculosis affecting organs outside the lungs (extrapulmonary tuberculosis) were recorded nationwide. However, only 27 cases or 2.5 percent were due to tuberculosis of the urogenital system.
Causes
A tuberculosis disease first manifests itself in a different place; the so-called primary focus is often in the lungs. As the disease progresses, however, the tuberculosis pathogens can also infect other organs, to which they usually reach via the bloodstream.
As a result, secondary or organ tuberculosis can develop. If the kidneys, the adrenal glands, the urinary tract and the urinary bladder or the sexual organs are affected by such a colonization of tuberculosis pathogens originating from the primary focus, urogenital tuberculosis develops.
Typical Symptoms & Signs
- mostly symptom-free
- Pain and burning when urinating
- flank pain
- blood in the urine
- constipation
- gas
- Intermenstrual bleeding or menstrual disorders in women
Diagnosis & History
About twenty percent of urogenital tuberculosis diseases do not cause the affected patients any symptoms. When symptoms do occur, they tend to be uncharacteristic, such as difficulty urinating, flank and other pain, pyuria or blood in the urine, and bloating and constipation.
Bleeding disorders or a lack of menstruation are also observed in women. If the man’s epididymis is affected, painful swelling and redness can form. Various methods are used to diagnose urogenital tuberculosis. The tuberculin test plays an important role here, but is not conclusive and must therefore be combined with other diagnostic methods.
A chest x-ray is used to determine whether the patient has primary tuberculosis of the lungs. Other diagnostic methods are the culture detection of TB pathogens in the urine, which takes about four weeks, the polymerase chain reaction (PCR) to detect the pathogen in the urine, urography, laparoscopy and the detection of the pathogen in histological preparations using the polymerase chain reaction (PCR ).
In female patients with suspected urogenital tuberculosis, there is also the possibility of detecting the pathogen in the menstrual blood or in a biopsy of the endometrium.
At the onset of urogenital tuberculosis, so-called minimal lesions appear in the tissue of the kidneys or other urogenital organs. As a result, a caseating tuberculoma forms, which over time develops into a calcified area. The further course of the disease depends largely on the immune status of the affected patient.
If the urogenital tuberculosis progresses, central tissue destruction ( necrosis ) and calcifications in the kidneys increase. The close proximity of necrotic parts and the cavity system in the kidney favors the development of deformities. For example, calyx cavities, renal calyces, papillary necrosis, but also calyx neck stenosis or renal pelvis outlet narrowing can form. The final stage of renal tuberculosis is the so-called putty kidney.
At this stage the organ consists almost entirely of caseating necrosis and has completely lost its function. If scarring forms in the ureters as a result of urogenital tuberculosis, this can result in urinary stasis and, in the worst case, hydronephrosis, which can then also lead to the loss of function of the affected kidney.
In addition to the kidney and urinary tract problems described, urogenital tuberculosis can also manifest itself in the female or male genitalia. In almost all women, the mucous membrane of the fallopian tubes is affected on both sides and the infection spreads into the uterus. If the infection reaches the uterine cavity, it often leads to infertility.
In developing countries such as Bangladesh or India, urogenital tuberculosis is one of the most common causes of infertility in women, and in earlier years tuberculosis of the female genitals was often found as an incidental finding during sterility diagnostics. In men, tuberculosis pathogens can reach the epididymis via the bloodstream, sometimes even without involving the kidneys.
The pathogens can also spread to the testicles and prostate via the seminal ducts. If tuberculosis affects the genital organs, it must be expected that the disease will lead to infertility in about nine out of ten cases.
Complications
Urogenital tuberculosis does not always lead to symptoms or complications. In some cases, it can also be completely symptom-free, so that it is only diagnosed relatively late for this reason. In many of those affected, however, urogenital tuberculosis leads to very severe pain when urinating.
This pain is burning and has a very negative effect on the mental state of the patient, so that depression or other mental upsets can sometimes occur. Flank pain can also occur and make everyday life difficult for those affected. The urine is bloody in urogenital tuberculosis, which can also lead to a panic attack.
Furthermore, the disease also leads to flatulence or constipation and reduces the patient’s quality of life enormously. In women, the disease can also lead to heavy menstrual bleeding and pain. In most cases, urogenital tuberculosis can be treated relatively easily with the help of medication.
There are no particular complications to be expected. However, those affected are dependent on taking the medication for a long time. With successful treatment, the patient’s life expectancy will not be negatively reduced by the disease.
When should you go to the doctor?
Since urogenital tuberculosis cannot heal on its own, the person affected should see a doctor as soon as the first symptoms or signs of the disease appear. Only early diagnosis and treatment can prevent further complications or worsening of the symptoms. A doctor should be contacted if the patient suffers from painful urination. There is usually a slight burning sensation or itching.
In many cases, urogenital tuberculosis is also noticeable through bloody urine. Some of those affected also suffer from constipation or flatulence and thus a significantly reduced quality of life. In women, urogenital tuberculosis can also lead to bleeding between periods or to a disturbed menstrual cycle. You should also contact a doctor if the symptoms persist and do not go away on their own. As a rule, urogenital tuberculosis can be treated well by a urologist.
Treatment & Therapy
The standard treatment of urogenital tuberculosis today is a combination therapy. Usually, isoniazid, rifampicin and pyrazinamide are used. If necessary, these active ingredients can also be combined with ethambutol. The therapy must be continued consistently over a longer period of time. Normally, six months can be assumed.
If therapy is ineffective, surgical resection is usually required. This applies in particular if the urogenital tuberculosis has led to the development of a cemented kidney or to hydronephrosis.
Prevention
Since urogenital tuberculosis is a secondary disease, direct prevention is not possible. The most effective prophylaxis is therefore to avoid a primary infection or to diagnose it as early as possible.
Because the earlier a primary tuberculosis infection, for example in the lungs, is discovered and treated, the lower the risk that pathogens will spread and organ tuberculosis such as urogenital tuberculosis will develop.
Aftercare
Follow-up care after recovery from urogenital tuberculosis depends on the therapy used. Since it is not a primary but a secondary disease, there is no risk of infection, which simplifies behavior during the drug treatment, which lasts up to 18 months. Normally, the disease is cured during long-term therapy.
It is crucial that the patient strictly follows the instructions for taking the medication, even if this is associated with unpleasant side effects. Aftercare after successful medication is then mainly aimed at strengthening the body’s own immune system in order to avoid relapses as far as possible. Despite actual or apparent healing of the urogenital tuberculosis, further follow-up treatment consists of self-observation.
If symptoms appear that indicate a possible return of the disease, a wide variety of examination methods can provide clarity. It then turns out whether it is a false alarm or whether one of the organs in question is affected. In some cases, even advanced findings can result.
They indicate an immediate need for action. This may not only consist of a new medication phase, but may also require surgical intervention to remove stenoses or to interrupt and stop the progression of the urogenital tuberculosis in certain organs. These serious cases also require parallel treatment with medication.
You can do that yourself
Urogenital tuberculosis is treated with medication. The most important self-help measure is compliance with the doctor’s instructions regarding the intake of medication. Typically used preparations such as isoniazid or rifampicin often cause side effects such as gastrointestinal disorders or allergies. If symptoms of this kind are noticed, a doctor’s visit is recommended.
After six months of combination therapy, the urogenital tuberculosis should have subsided. If the treatment does not work, an operative attack is necessary. After the operation, the surgical wound must be carefully observed so that any inflammation or bleeding can be treated quickly. In the event of complications, rapid medical clarification is also important here. In addition, patients should cool the affected area well and take care of it carefully. The doctor can prescribe suitable disinfectants with which the wound can be optimally treated. If necessary, natural remedies from the field of homeopathy can also be used. This must first be discussed with the doctor treating you.
Urogenital tuberculosis can significantly limit well-being, which is why the focus after the disease is on regaining quality of life. Patients can now resume hobbies, lifestyle habits and professional activities that were neglected during the therapy phase, which lasted several months.
