Genitourinary Tuberculosis

Popping the Corkscrew

Introduction Tuberculosis remains the leading cause of death from infectious disease compounded by the high prevalence of HIV amongst the population. Urogenital TB is infection of the urinary and genital systems by mycobacterium tuberculosis. The genitourinary tract is the commonest site after lungs for tuberculosis infection.

Clinical Patients usually present with urinary symptoms (frequency,

dysuria and urgency). Lack of response to standard antimicrobials often raises the suspicion for GUTB. Renal TB can lead to hypertension via activation of Renin-angiotensin system. Genital TB can lead to subfertility in both males and females.

CASE 1

Female patient presented with urosepsis and renal impairment. Had history of disseminated TB 5 years prior to presentation that culminated in right nephrectomy.

A. US showing dilated calyces and debris B. Tortuous left ureter (corkscrew ureter) C. Small volume bladder with reflux into the

ureter.

CASE 2 Male patient known with GUTB and completed treatment. Informal ultra-sound showed bilateral hydronephro-

sis. CT IVP performed. A. Bilateral hydronephrosis B. Non-excreting left kidney C. Fibrosed small volume bladder with

thickened wall (thimble bladder)

CASE 3 Female patient presented with persistent lower abdominal pain and raised inflammatory markers (CRP 130, WCC 24). CT IVP performed.

A. Dilated right upper pole calyces B. Dilated right lower pole calyx C. Phantom right upper pole calyces

B

C

A B C

B C

A

A

Dr. Bornaventure Matimati, Registrar Department of Radiology, Groote Schuur Hospital University of Cape Town

Dr. Maja Wojno, Consultant

Department of Radiology, Groote Schuur Hospital University of Cape Town

Conclusion Genitourinary TB remains a challenge requiring multidisciplinary approach Imaging plays an important role in the timely diagnosis of GUTB and detection of complications Although imaging findings may be highly suggestive of TB, mycobacterial cultures and histopathological analyses are still required to

make a definitive diagnosis Interventional radiology is very crucial in management of complications of GUTB Genital TB can result in infertility.

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