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2017 ; 6
(2
): 222-233
Nephropedia Template TP
gab.com Text
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Genital tuberculosis: current status of diagnosis and management
#MMPMID28540230
Yadav S
; Singh P
; Hemal A
; Kumar R
Transl Androl Urol
2017[Apr]; 6
(2
): 222-233
PMID28540230
show ga
Genitourinary Tuberculosis (GUTB) is the second most common extra-pulmonary
manifestation of tuberculosis (Tb) and an isolated involvement of genital organs
is reported in 5-30% of the cases. Genital involvement results from primary
reactivation of latent bacilli either in the epididymis or the prostate or by
secondary spread from the already infected urinary organs. The epididymis are the
commonest involved organs affected primarily by a hematogenous mode of spread. Tb
is characterized by extensive destruction and fibrosis, thus an early diagnosis
may prevent function and organ loss. The gold standard for diagnosis is the
isolation and culture of mycobacterium tuberculosis bacilli and in the cases of
suspected GUTB, it is commonly looked for in the urinary samples. All body fluid
specimens from possible sites of infection and aspirates from nodules must also
be subjected to examination. Radiologic investigations including ultrasonography
and contrast imaging may provide supportive evidence. Anti-tubercular
chemotherapy is the first line of management for all forms of genital Tb and a 6
months course is the standard of care. Most patients with tubercular
epididymo-orchitis respond to antitubercular therapy but may require open or
percutaneous drainage. Infertility resulting from the tubercular affliction of
the genitalia is multifactorial in origin and may persist even after successful
chemotherapy. Multiple organ involvement with obstruction at several sites is
characteristic and most of these cases are not amenable to surgical
reconstruction. Thus, assisted reproduction is usually required. Post treatment,
regular annual follow up is recommended even though, with the current multi drug
therapy, the chances of relapse are low.